Bipolar Disorder (BD) is one of several serious mental health conditions that has a significant impact on a person's life, and contributes to a high degree of health burden worldwide. Research suggests that some Indigenous populations experience higher community prevalence rates of BD, including Maori the iIndigenous peoples of New Zealand. A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities.
The New Zealand health system, while planning reform, is currently structured hierarchically. This includes: primary care delivered by doctors in General Practice (GPs); community-based services; outpatient and inpatient hospital services delivered regionally by 20 District Health Boards (DHBs); and non-governmental organizations (NGOs). Mental health care for BD generally requires a GP referral to DHB services, and can include periods of inpatient or community-based treatment delivered by multidisciplinary teams (MDT) within a psychiatric care model. The composition of services and teams can differ between DHBs, meaning experiences of care may change depending on where in New Zealand a person lives.
Based on a qualitative Kaupapa Maori Research methodology, a recent study analyzed critique from Maori patients with Bipolar Disorder (BD) and their whanau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Three themes reflected patients' critique of structural features of the New Zealand health system and their impact on service provision for Maori with BD and their whanau. The operational-accessibility sub-theme included patients' critique of the hours of service operation, including clinic hours, visitation times, and ward rounds; as well as processes for scheduling appointments, and the impact of these processes on access to BD services for Maori. In addition, patients identified constraints through insufficient resources in specific services or environmental features of facilities that limited their access to culturally safe, competent and equitable health care.
Structural factors also influenced accessibility of staff with specialist skills to treat Maori with BD, like psychiatrists, psychologists and Maori mental health workers. Patients recognized that staffing-accessibility reflected current recruitment and retention priorities, meaning improved accessibility for Maori required prioritization of staff with proven clinical and cultural competencies.
Transformational change therefore requires a commitment to monitor and address institutional racism driving inequitable access to effective care for Maori with BD and their whanau in the health system. As New Zealand prepares for significant health system reform, a commitment to equity and implementation of previously recommended structural change is needed, along with ongoing evaluation and refinement of structural changes to ensuret the efficacy for whanau Maori.
【用戶】熊熊讚
【年級】高三下
【評論內容】(A) 紐西蘭精神健康系統的結構性障礙及解決方案(B) 紐西蘭毛利人的雙極性情感障礙症狀(C) 紐西蘭衛生系統的人員配備-可近性(D) 紐西蘭的土著居民和製度性種族主義(E) 紐西蘭地區衛生委員會的轉型變革A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities. The New Zealand health system, while planning reform, is currently structured hierarchically.最近對原住民雙相情感障礙的系統性回顧指出，證據基礎極其有限，建議進行原住民研究，旨在確定係統性因素對當前健康不平等的影響。 紐西蘭衛生系統雖然正在規劃改革，但目前的結構是分層的。