Addressing cultural differences in institutions: changing health practices in New Zealand

Abstract

‘Maori destiny has been controlled by Pakeha’ to the degree that even their ‘culturally determined’ forms of mental illness were and still are, being diagnosed, treated, and controlled by Pakeha within the institutions without consideration whether these practices are culturally of value to Maori people’ (W. Maniapoto, personal communication) . The Mason Report (Mason, Ryan & Bennett, 1988) reflected societal concern in its statement ‘Maori people make up 10% of the total population, commit 37% of all offences but comprise 50% of the prison population’ (p.228). This concern is reflected within the psychiatric institution population where Maori and other cultural minorities are disproportionately represented, struggle to have their concerns heard, and struggle to be in a position of influence to effect change. Since 1990 and the New Zealand Department of Health’s acceptance of the validity of the Treaty of Waitangi as a document on which to negotiate change, a concerted attempt has been made to redress inequities within the health institutions. Maori people, however, continue to press toward ‘tino Rangatiratanga’ (self determination) in the areas that affect them most. With the introduction of the Health and Disability Services Act 1992 this may be a realisable goal with the Government’s promises to encourage ‘greater participation of Maori people at all levels; resource allocation priorities which take account of Maori health needs and perspectives; and the development of culturally appropriate practices and procedures as integral requirement in the purchase of health services’. (Department of Health, 1992).