Effective and respectful interaction with Maori: How the regulators of health professionals are responding to the Health Practitioners Competence Assurance Amendment Act 2019.

AIMS: To ascertain the response of registered health professional regulators to the legislated requirement under the Health Practitioners Competence Assurance Amendment Act 2019 (HPCA Amendement Act) that practitioners are culturally competent and, specifically, enabling "effective and respectful interaction with Maori". METHOD: A document analysis of the extent to which the culturally competent requirement is indicated in information about professional competencies within publicly available information of the 17 responsible authorities (RAs) that govern health practitioners under the Health Practitioners Competence Assurance legislation. RESULTS: Three years after the amendment to the original Act (HPCA Act) requiring health professionals to be culturally competent specifically in relation to interacting with Maori, only four of the 17 RAs fully reference the amended requirement, and only two RAs link this specific cultural competence to the requirements of the amended Act (HPCA Amendment Act). The majority of the RAs have yet to integrate references to engaging with Maori in this way into their professional competencies. CONCLUSIONS: Culturally competent practice is only meaningful once it is enacted by individual practitioners in their interactions with others. It is imperative for RAs to include the cultural competence requirement into their published information about professional competencies as this would signal to the profession, practitioners, and wider community that effective and respectful interaction with Maori is a fundamental expectation of all health practitioners in this country. Other issues identified during the analysis suggest an emphasis on administration and bureaucracy. This presents an opportunity for consolidating the practice of RAs including how key functions are expressed and promulgated.

An Integrative Review of Contemporary Perspectives on Videoconference-Based Therapy-Prioritising Indigenous and Ethnic Minority Populations in the Global South.

An integrative literature review was undertaken as a means of drawing together contemporary perspectives on the outcomes and affordances of videoconference-based therapy. This review was conducted in a way which placed emphasis on the need for mental healthcare strategies which are mindful of the cultural and social needs of indigenous and ethnic minority populations, particularly those situated in the Global South. The review was undertaken using an inverse funnelling approach which sought to prioritise literature on videoconference-based therapy literature which specifically focused on indigenous and ethnic minority populations. A series of general and population specific searches across relevant health databases were supplemented by a simultaneous search of Google Scholar. The PICOS search tool was used in developing the search terms, and data was processed using an inductive approach to thematic analysis. A final dataset of 43 articles were included in the review. This body of literature encompassed an international range of studies and included perspectives informed by quantitative, qualitative and mixed methods research. Four key themes were identified across the reviewed literature: indigenous and ethnic minority populations, therapeutic relationships, clinical outcomes and technical and logistical considerations. Based on our findings, there is reason to believe that videoconference-based therapy can be made to be just as effective as offline, face-to-face modes of delivery. However, research into the efficacy, impact and cultural implications of this technology in relation to indigenous and ethnic minority populations represents a significant gap within contemporary literature.

Embedding lived experience expertise across the mental health tertiary education sector: An integrative review in the context of Aotearoa New Zealand.

WHAT IS KNOWN ON THE SUBJECT?: An important step towards improving mental health outcomes is the realignment of tertiary mental health education and research in a way which places strategic value on experience-driven involvement in mental health and addiction-related care. One of the most widely recognized ways of achieving this is by increasing representation of individuals with first-hand experience of mental health and addiction distress (also known or referred to as Experts by Experience or EBE) within the tertiary sector. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Benefits of tertiary EBE representation such as improving student's preparedness for practice and the empowerment of mental health consumers are consistently reported throughout the literature. In striving towards these outcomes, it is crucial we remain mindful of relevant and often-reported hurdles such as stigma and improper implementation. By using Aotearoa New Zealand as a case study, the need for approaches to increasing EBE representation which is conscious of diverse cultural contexts, perspectives and identities is highlighted. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review draws together a broad range of factors associated with improving clinical practice. These include the potential for EBE representation to improve outcomes for trainee clinicians, and the incorporation of consumer-driven perspectives into evidence-based practice. This review further highlights the need for EBE representation to be implemented in a way which is responsive to the cultural needs and nuances of mental health education and practice in Aotearoa New Zealand, and, similarly in other countries. ABSTRACT: Introduction There is potential value in increasing representation of expert by experience (EBE) involvement in mental health education sectors. This approach to improving mental health outcomes is here explored in the context of Aotearoa New Zealand's tertiary education sector. Aim/Question This review sought to identify potential outcomes, benefits and barriers associated with EBE representation in tertiary institutions, whilst critically analysing these strategies in the context of Aotearoa New Zealand's mental health education sector. Method Data retrieved from electronic databases were subjected to critical appraisal and thematic analysis. The integrative review drew from a final data set of 113 articles. Results An integrative review of our search results indicated that moving towards a tertiary mental health model in which lived experience plays a central role has the potential to benefit both teaching and research in the tertiary sector. Discussion The interplay between contemporary perspectives on tertiary EBE representation and the cultural needs and nuances of Aotearoa New Zealand's tertiary sector highlights the need for critical and careful approaches to EBE representation. Implications for clinical practice Findings surrounding tertiary EBE representation have direct implications for the training of mental health practitioners and the evaluation and development of clinical practice outcomes and procedures.

Working (it) Out: An Heuristic Enquiry Into Psychotherapy and Physical Exercise.

Psychotherapy is predominantly a sedentary practice that, with rare exceptions, does not involve much physical activity on the part of either the client or the therapist. In response to this situation, the article examines three concerns: the impact of sedentarism on psychotherapists; the disconnection between the evidence of the benefit of physical exercise on psychological wellbeing and the predominant focus in psychotherapy on the sedentary mind; and the implications of the disconnection between psychotherapists' own minds and bodies. of the method employed was an heuristic enquiry conducted by the first author (reflected in the "I" and the "my" voice in the article), under the supervision of the second author. Drawing on and interweaving relevant literature throughout, the enquiry explores the first author's own relationship with exercise and, specifically, boxing, as both a practice (i.e., physical exercise) and as a metaphor for the heuristic research process (a psychological and intellectual exercise).

The whole and inclusive university: a critical review of health promoting universities from Aotearoa New Zealand.

As well as serving as a critic and conscience for societies, universities are elite sites of privilege which, at a surface level, are unlikely locations for health promotion interventions. This paper provides a critical review of the existing health promoting universities (HPU) approaches which is informed by health promotion values. It explores the silence in the global literature around issues of structural discrimination such as the sexism, homophobia and institutional racism that can thrive within university settings. The existing literature also reveals a very limited engagement about positive mental health or indigeneity. In response, this paper brings together these three factors-structural discrimination, mental health, and indigeneity-all of which the authors consider are criterial to health and its promotion. The authors introduce the New Zealand university landscape, in which there are eight Western universities and three whare wananga (Maori universities), and, drawing on a survey of their Charters and other official statements, offer a moemoea (vision or dream) of an HPU that addresses structural discrimination, is based on holistic conceptions of health, and is centred on indigenous worldviews and concerns.

Unravelling the whariki of Crown Maori health infrastructure.

New Zealand's central government, and more specifically the Ministry of Health, consistently acknowledges their special relationship with Maori and the strategic importance of Maori health, and certainly, strengthening Maori health is critical to addressing systemic health inequities. This paper, framed in terms of the Crown principles attributed to the Treaty of Waitangi, ie, participation, protection and partnership, examines three structural decisions that threaten to unravel the whariki (foundational mat) of Crown Maori health policy infrastructure. These include the disestablishment of the Ministry of Health's policy team, Te Kete Hauora, revoking mandatory district health boards' (DHB) Maori health plans and reporting, and downscaling the requirements of DHBs to consult. These actions appear to breach the Articles of te Tiriti o Waitangi and may be cited as such in the forthcoming WAI 2575 kaupapa health hearing before the Waitangi Tribunal. The authors call for the Ministry of Health to embrace its Treaty obligations, and to protect and reinstate the whariki of Maori health infrastructure.

Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial.

AIM: This paper aims to describe the training preparation for health visitors who took part in the intervention arm of a cluster randomised controlled trial and economic evaluation of training for health visitors - the POstNatal Depression Economic evaluation and Randomised (the PoNDER) trial. A secondary aim is to make available, by electronic links, the training manuals developed for and used for the cognitive behavioural approach (CBA) and the person-centred approach (PCA) training for the health visitors. The paper is of relevance to health visitors, general practitioners, nurse practitioners, midwives, clinical psychologists, mental health nurses, community psychiatric nurses, counsellors, and service commissioners. BACKGROUND: The trial clinical outcomes have been published, indicating the pragmatic effectiveness of the package of training for health visitors to identify depressive symptoms and provide a psychologically informed intervention. The training was associated with a reduction in depressive symptoms at six months postnatally among intervention group women and some evidence of a benefit for the intervention group for some of the secondary outcomes at 18 months follow-up. METHODS: The two experimental interventions examined in the PoNDER trial built upon promising work on the potential for psychological interventions to help women recover from postnatal depression as an alternative to pharmaceutical interventions and to address the limitations of previous research in the area. FINDINGS: The package of health visitor training comprised the development of clinical skills in assessing postnatal women and identifying depressive symptoms, and the delivery of a CBA or a PCA for eligible women. This was the largest trial a health visitor intervention and of postnatal depression ever conducted. We are aware of no other rigorously performed trial that has published details of an extensively tested training programme for the benefit of health-care professionals and clients.