Compulsory Community Treatment Orders and health outcomes for Maori in New Zealand.

ABSTRACT

BACKGROUND: We have previously analysed outcomes for all community treatment orders commenced during a 10-year period in New Zealand. Given Te Tiriti O Waitangi obligations to scrutinise health and consider equity for Maori, we completed this analysis to consider community treatment-order outcomes according to ethnicity. METHODS: Ministry of Health databases provided demographic, service use and medication dispensing data for community treatment-order recipients between 2009 and 2018. As non-Maori on community treatment orders are older, less deprived and less likely to be diagnosed with a Psychotic Disorder, data were categorised according to age (<35/⩾35 years), level of deprivation (New Zealand Dep levels ⩽3, 4-6 and ⩾7) and diagnosis (Psychotic Disorder/non-Psychotic Disorder). The incidences of key outcome measures (admissions, community care, medication dispensing) were calculated for periods on/off community treatment orders for Maori and non-Maori to consider the differential impact of community treatment orders according to ethnicity. RESULTS: Maori have high rates of community treatment order utilisation and are younger, more likely to be diagnosed with a Psychotic Disorder and spend longer receiving compulsory treatment than non-Maori. Non-Maori are more likely to receive more additional depot antipsychotic medication on-community treatment orders compared with periods off-community treatment order than Maori but other clear patterns of response distinguishing between Maori and non-Maori were not present. CONCLUSION: The differences between Maori and non-Maori for community treatment-order utilisation suggest the presence of structural inequity in underlying mental illness distribution and treatment provision. Maori cultural expertise at all levels of healthcare including healthcare planning and delivery is required to make advances and reduce disparity.