The physical health and premature mortality of Indigenous Maori following first-episode psychosis diagnosis: A 15-year follow-up study.

BACKGROUND: People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Maori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis. OBJECTIVE: Compare Maori and non-Maori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis. METHODS: A cohort (N = 14,122) of young people (16-24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan-Meier and adjusted Cox proportional hazards models, Maori (n = 5211) and non-Maori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years. RESULTS: In the 15 years following first-episode psychosis diagnosis, Maori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan-Meier plots show hospitalisation and mortality inequities emerging approximately 4-7 years following first-episode psychosis diagnosis. CONCLUSIONS: Maori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.

Indigenous Maori responses to COVID-19: He waka eke noa?

The COVID-19 pandemic of 2020 has had significant impacts on communities and infrastructures across the globe. Indigenous health experts have called for culturally responsive Government support to mitigate pre-existing inequities and vulnerabilities in Indigenous communities. In Aotearoa New Zealand, official responses to the pandemic typically reflect the worldviews of the settler majority, while Maori interests are treated as part of the national concern. Using autoethnographic, Indigenous voice and an Indigenous wellbeing model, Whiti te Ra, this article contributes insights into Maori cultural values as they were reported in online platforms during the Level 4 lockdown period of March-July, 2020. The authors recorded multiple examples of Maori cultural values and practices that offered individuals, families and communities a digital-social space of safety and hope to build relational resilience, and to mitigate the effects of the COVID-19 lockdown. Observations and responses aligned to the model's six dimensions of relational wellbeing: Maori language, the natural environment, spirituality, creative and performing arts, family (and extended family) values and genealogical connections. The observations highlight that Maori have a multigenerational approach to crisis management based on ancestral wisdom and experience that can inform Government responses.

A literature review: addressing indigenous parental substance use and child welfare in Aotearoa: a Whanau Ora framework.

Parental substance use disorders (SUDs) for Maori, the indigenous people of Aotearoa/New Zealand and an ethnic minority, are considered to be contributors to adverse effects on outcomes for their children. This article offers a review of international and Aotearoa literature in regard to key considerations for Maori parents with SUDs who present to an Alcohol and Drug specialist for assessment and treatment. Factors to increase positive outcomes for Maori children of parents with SUDs are promoted. Effective adult AoD services provide support to parents with SUDs through comprehensive assessment and intervention plans that consider both individual and familial risk and protective factors. In this context, it is imperative that possible child welfare issues are identified early to ensure prevention or intervention. The AoD workforce must have the knowledge and skills to facilitate access to other relevant sectors, such as education, employment, and housing. An AoD workforce that is effective with Maori must not only have these abilities, but also have at least some basic knowledge and skills in Whanau Ora philosophy and Whanau-centered best practice. To address these processes, AoD specialist services need to acquire a set of knowledge and skills. These include increasing the knowledge and skills associated with the realities of lifestyles centered in low socioeconomic communities and co-occurring issues that contribute to poor health outcomes. To assist Maori, several key processes are proposed. This includes working in a Whanau-centered approach with Whanau as a collective entity, based on Maori foundations; understanding intergenerational dynamics; and endorsing a group capacity for self-determination. Research and training in Whanau ora philosophy and Whanau-centered best practices will be essential for developing an appropriate AoD workforce, which would provide the foundations for improving AoD service delivery for Maori parents with SUDs.