Mental Health Cultural Safety
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Mental Health Cultural Safety



mental health

mental health



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  • 1. Beliefs All cultures are grounded in a set of beliefs, or shared knowledge and ideas about the nature of life. 2. Values All cultures set values or shared standards for what is right and desirable 3.Norms Translate beliefs and values into specific rules for behaviour 4.Technology Sets the tone of the culture, influencing not only how people work, but also how they socialise & think about the world 5.Symbols Are designs or objects that have acquired special cultural meaning 6. Language A key element of culture – communicate by means or words, sounds, gestures which are combined in many different ways to convey messages Provides a clue to way the world is viewed
  • Class Question: Where are we now with these goals that were developed in 2002? – Are there any kauapapa Maori services in this area, have they increased in number since 2002? What new programme pilots there been in areas of need? Any evidence of key linkages with regional mental health networks? Recruitment and retention of Maori in the mental health workforce Who is monitoring progress – Mental Health Commission
  • Who provides kaupapa Maori services in Northland?

Mental Health Cultural Safety Mental Health Cultural Safety Presentation Transcript

  • Cultural Safety & Mental Health Practice Unit 5
  • Key Aspects to Culturally Safe Practice
    • How the nurse understands themselves in relation to service users who may be from different backgrounds
      • Differences may include age or generation, gender, sexual orientation, occupation and socioeconomic status, ethnic origin, religious or spiritual belief and disability (NCNZ 2002)
  • Some history….
    • Until 1960’s mental health nursing practice in NZ was mostly confined to large state psychiatric institutions
    • Nursing care connected with the work of psychiatrists – a medical model of care
      • Nurses assisting in treatments, observing , reporting on patient behaviour, ensuring patient safety and containment.
  • History continues…
    • Social class and gender shaped how people with mental illness received care.
    • Culture noted but egalitarian ethos of treating everyone the same was a core value of nursing knowledge and practice.
    • Significant influence on future mental health education was interpersonal relationship model developed by Peplau
  • A move forward…post 1960
    • Peplau shifted focus from treating everyone the same to looking at the interpersonal nature of the relationship between nurse and patient.
      • Referred to as the therapeutic relationship
    • Nurse has a key role in patient treatment and recovery
      • Nurses developed different ways of providing care
      • Included group therapy, training in psychodrama, psychoanalysis and behaviour modification
  • 1970 - 1980
    • Ideal of community treatment saw a small number nurses working outside the hospital setting.
    • Nurses gained a wider perspective
      • Attention to impact of socio-economic and cultural factors on mental health & well being
    • Preference for community care culminated in process of deinstitutionalisation.
      • Over next 2 decades large institutions closed
      • Marginalised groups ( women, indigenous groups, physically & mentally disabled, gays & lesbians) demanded change in power structures
        • Sought visibility & inclusion in decision making processes in dominant institutions.
  • 1990’s
    • Challenges influenced the development of the Mental Health Act (1992) and the framework for cultural safety
    • Since 1992 cultural safety inherent part of nursing education curricula (NZNC 2002)
  • Treaty Principles (1) Partnership
    • Nurses working with Maori on goals aimed at achieving health gains
      • Act in good faith as a treaty partner, therefore can work in partnership on agreed interests in order to achieve positive health outcomes
  • Treaty Principles (2) Protection
    • Nurse recognises that the health of Maori is a Taonga ( treasure) and acts in ways to protect it.
      • Being responsive to the needs of Maori health consumers
      • Providing a supportive environment that is welcoming and encourages Maori participation in their health experience
  • Treaty Principles (3) Participation
    • Nurses recognise the rights of Maori as tanagata whenua to equitable access and delivery of health services
      • Ensuring Maori participation in all phases of assessment , planning and delivery of health and disability services
      • Ensure Maori are afforded the same access and opportunities to healthcare and service delivery as non Maori
        • Where these opportunities are absent facilitate their access
  • Implementing the Treaty Principles
    • Requires recognition that nurses hold positions of power in their relationships with Maori health consumers.
    • Implementing the principles is based on Maori having the autonomy and authority to determine their health needs and health experience within context of their beliefs and practices
  • Meeting the health needs of Maori Patients
    • Maori are structurally disadvantaged and Maori and non Maori hold different views of health.
      • Maori knowledge needs to be seen as legitimate and validated
      • There needs to be the capacity and flexibility to engage individuals who identify as Maori to express their ‘Maoriness’ freely.
      • Informed choice - right to be given adequate information on kaupapa Maori services or mainstream services
  • Underlying Principles of Cultural Safety
      • Understanding personal, professional and institutional power and how these impact on the nurse client relationship and care delivery
        • Ensure that provision of care enables patient to have control and power over their situation
        • Maintain safety
        • Care delivered in partnership with patient and whanau
      • Congruent with the Principles of Te Tiriti o Waitangi
        • Partnership, Protection, Participation
  • Remember....
    • All cultures consist of 6 basic elements:
      • Beliefs
      • Values
      • Norms & sanctions
      • Technology
      • Symbols
      • Language
  • Cultural Issues for Mental Health
    • Maori continue to be over represented as consumers of mental health services (Durie 1997).
    • How can the principles of cultural safety be ratified to provide the most appropriate care for mental health consumers?
      • Government strategy developed
  • Te Puawaitanga Maori Mental Health National Strategic Framework
    • Goals and objectives for District Health Boards
    • Goal 1 :
    • Provide comprehensive clinical, cultural and support services to at least 3 percent of Maori, focused on those who have the greatest mental health needs. Goal 2 :
    • Ensure that active participation by Maori in the planning and delivery of mental health services reflects Maori models of health and Maori measures of mental health outcomes. Goal 3 :
    • Ensure that 50 percent of Maori adult tangata whaiora will have a choice of a mainstream or a kaupapa Maori community mental health service. Goal 4:
    • Increase the number of Maori mental health workers (including clinicians) by 50 percent over 1998 baselines. Goal 5 :
    • Maximise opportunities for intra- and intersectoral co-operation.
  • Service Elements of a Kaupapa Mental Health Service
    • Whanauntanga
    • Whakapapa
    • Cultural assessment
    • Empowerment of tangata whaiora and whanau
    • Te reo Maori
    • Tikanga Maori
    • Kaumatua guidance
    • Access to traditional healing
    • Access to mainstream health services
    • Quality performance measures relevant to Maori.
  • Class Exercise (1)
    • Read
      • “ Nursing Under a Maori Kaupapa” by Fiona Cassie, NZ Nursing Review (2004).
      • “ A Practice Story” – Ruby.
    • In Groups answer the following question:
      • How might a kaupapa Maori Service have shaped Ruby’s care?
      • Consider the components of culture in your answer
  • Class Exercise (2)
    • Read “ Put your self in my shoes” By Noel O’Hare. Listener (2004)
    • Answer the following question:
      • How do I, as a health professional, work to support people who might have different ways of being?
  • References
    • Cassie, F., (2004 December) Nursing under a Maori kaupapa. NZ Nursing Review. 6-8.
    • Ministry of health (2002) Te Puawaitanga Maori Mental Health Strategy. Wellington: MOH
    • O’Hare, N. (2004 May 22) Put yourself in my shoes. Listener . 36
    • Wilson, D., (2005 April) The Treaty of Waitangi, Nurses and Their Practice. NZ Nursing review. 12
    • Wepa. D.(2005) Cultural Safety in Aotearoa New Zealand. Auckland: Pearson Education.