Which family--what therapy: Maori culture, families and family therapy in New Zealand.

New Zealand is a relatively young and small country which has seen steady migration for nearly seven centuries. Despite a long history of rivalry and hostility between Maori and European values, the country has also seen some significant synergism between the two cultures. For the last three decades Asians have also migrated at a significant pace. The country faces the challenge of delivering quality mental health services to such cultures which are bifurcated in being socio-centric (Maori, Pacific Islanders and Asian total 32% combined) or ego-centric (European total 68%). Significant progress has been made in including families of the mentally ill in their treatment and care planning. Legislative requirements have been introduced for the family to be consulted in the treatment of those who are being compelled to receive psychiatric care under the Mental Health Act. Models of family therapy developed through innovation meeting the unique local needs or adaptation of existing models from overseas are being used. An overview of such family therapy modalities is presented.

The contributions of culture and ethnicity to New Zealand mental health research findings.

UNLABELLED: BACKGROUND AND MATERIAL: In the last five years a number of studies have been conducted in specialist psychiatric and primary care populations in New Zealand which have allowed comparisons in terms of clinical phenomena and therapeutic experiences between Mâori (the indigenous people of New Zealand) and non-Mâori. These studies were reviewed in terms of the methodology used, their major findings and their implications. DISCUSSION: In specialist psychiatric services Mâori were more likely to present with hallucinations and/or aggression and less likely to present with depression and/or episodes of self-harm. They were overly represented in those with schizophrenia. Mâori were more likely to be involved in acts of aggression and to be secluded, and an equivalent episode of care for Mâori appeared to be significantly more costly than for non Mâori. Other studies, conducted in prison and community-based samples, suggested that Mâori were less likely to access care and, when given a diagnosis of depression, less likely to be prescribed anti-depressant medication.The rates of depression were significantly higher in Mâori (women) and Mâori were also overly represented in those with anxiety and substance misuse disorders. These differences remained even after the sample was standardised for socio-economic status. Further exploration of the genesis and implications of these findings, derived from a strong and relatively well-defined indigenous people, may usefully inform the more general issues of culture and its significance for diagnosis, classification and service use. CONCLUSIONS: While the methodologies used and the actual results gained differed across studies, there do seem to be differences in phenomenological profiles at presentation, in the diagnostic patterns, the cost of care, and the therapeutic experiences between Mâori and non-Mâori New Zealanders. These differences may reflect actual differences between certain ethnic groups, which then explain the differences in the experiences of those users, or they may reflect inadequacies on the parts of non-MAori clinicians, their diagnostic tools and the services in which they operate, in catering for Mâori patients.

CAOS contribution to understanding cultural/ethnic differences in the prevalence of bipolar affective disorder in New Zealand.

OBJECTIVE: To examine whether data on the clinical profiles of psychiatric service users can inform the claim that Maori in the New Zealand community have an increased rate of bipolar disorder. METHOD: The standardized recordings of a variety of clinical phenomena previously collected in a New Zealand study of psychiatric service users was extracted for those persons who were diagnosed with a bipolar mental disorder. The individual clinical phenomena were then compared by ethnicity. RESULTS: The most dramatic result was the increased recording of high levels of overactivity or disruptive aggressive behaviour in Maori compared with European in psychiatric service users, despite which, the rates of the disorder did not significantly differ by ethnicity. CONCLUSION: In the community survey lay raters were deciding on the presence or absence of phenomena including hyperactivity without the contextual knowledge that clinicians use. It is possible that the Composite International Diagnostic Interview decision tree was being fed an excessive amount of that criterion.

Population-based funding formulae cultural coefficients: seeking a more equitable distribution of health dollars in New Zealand.

Evidence and argument for the allocation of funds to forensic psychiatric services to take account of the ethnic disparities in the use of the Justice System is presented. This would reflect the reality of the distribution of Service demand.