Mental Health Report Highlights Gaps for Rangatahi and Māori

Mental health leaders and Eastern Bay providers say more culturally responsive and youth-focused support is urgently needed.

A Te Hiringa Mahara Mental Health and Wellbeing Commission report has found mental health and addiction services have significant short comings for youth and Māori patients. 

Chief Executive Karen Orsborn said the system was not growing fast enough to support increasing youth and Māori mental health demand. 

"For young people, what we're seeing is quite an increase in the rates of psychological distress and that's driven by the world that our young people live in."

Digital, societal, educational, climate and financial stresses were contributing to youth mental health concerns, she said. 

"We have seen an increase in access to primary and community services, but we've seen a decrease in access to specialist services for young people,and that's a particular concern for us, given the increasing rates of distress."

Since the Wellbeing Budget in 2019, Orsborn said $460 million had been invested in new services and GP practices, including Māori, Pasifika and youth services. 

"The youth one in particular was co-designed with young people, so that's where we're seeing improved services are leading to more people getting the support they need in a timely way."

However, more work was needed to support early intervention and prevent wellbeing deterioration, she said. 

In the Eastern bay, mental health service providers have also raised concerns over youth mental health and rising youth drug use. 

Te Puna Ora o Mataatua Ngā Mata Waiora Counselling manager Matewai Wharepapa said rising substance use and worsening youth mental health could not be separated from wider social pressures.  

Cost of living pressures, social media, bullying and social isolation were all contributing factors, she said.  

"We no longer have a middle class. We've either got a low class or the really rich, and then we've got everybody else that's stuck in between." 

"And so, these rangatahi are left to their own devices and drugs and alcohol are just an outlet."

Many rangatahi were struggling with identity, belonging and connection to culture at a critical stage of their development.

Alongside bullying and increased social media, self-isolation and normalisation of drugs, alcohol, gambling and gaming were rising, she said. 

"It contributes to a further disconnect from our culture, from identity and who we are and that's a big stage in the rangatahi's life at that point is discovering who they are, what their purpose is in the world." 

Rangatahi were increasingly turning to AI and online support systems rather than face-to-face interactions, creating further isolation and disconnect from parents, she said.  

The Commission also highlighted concerns for Māori patients who often have higher mental health needs but poorer outcomes, she said. 

While the increase in kaupapa Māori community and primary services has been beneficial, Orsborn said more specialist services incorporating kaupapa Māori approaches were needed.

"What we've called out in this most recent report is that where there has been similar levels of investment in kaupapa Māori services, but there has been an increase in the overall amount of funding.

"So the proportional share of funding going to kaupapa Māori services has decreased when you look at it in comparison to the total."

Wharepapa said more kaupapa Māori and whānau-centred approaches were needed across the Eastern Bay to encourage Māori communities to seek support.

She said shorter wait times, improved coordination between government agencies and greater recognition of whānau-centred approaches would help improve outcomes. 

"Until that happens, we need more acceptance around whānau approaches and how impactful that is rather than targeted approaches to youth." 

The report also found Māori are more likely to be exposed to seclusion and coersion in mental health and addiction services. 

Experiences such as being medicated without consent, having freedom of movement restricted, being placed in solitary confinement or being prevented from leaving were more common for Māori patients, Orsborn said.

"We've heard a lot from people who have experienced seclusion that that's a harmful experience, it's traumatic often and it contributes to some undermining of trust between people and services."

An anonymous Eastern Bay mother said that during specialist appointments with her rangatahi who had been in a drug induced psychosis, appointments were cancelled at the last minute and doctors told the whānau they could only leave on the doctor's terms.

"The guy came in and he said, 'Well, you need me because if I don't sign her out, then you're not taking your child home.'"

With help from a community provider, she was able to get her tamariki a diagnosis and medication, but she said without the community provider, that would not have been the case. 

"I was engaging because I felt that someone cared.

"When you didn't follow through with your words, it was an issue for us because we have a bigger issue and the taonga was our child."

Orsborn said such situations needed to be eliminated, with both central government and service providers reflecting on their practices.

For rural areas and small communities where fewer service providers were available, Orsborn said services needed to listen to and respond directly to community needs.

"So it is about the services ensuring that they are meeting the needs of local communities, but also where can those people in those communities seek help in other forms?

"And that is one of the big pluses around digital and online, that people can reach out to national providers such as the National Telehealth Services to seek help when needed."

She said it was common for people in smaller communities to be hesitant about engaging with service providers because of confidentiality concerns.

"That's certainly something that we've heard about and we know there's longstanding stigma and discrimination and there's been a lot of work to reduce that level of discrimination and to encourage people to come forward.

"But it certainly sits within smaller communities that people may be reluctant to speak up."

The anonymous Eastern Bay mother, said she had been hesitant to engage with local service providers because of stories she had heard and concerns that details of her family's situation would quickly become known throughout town.

"And what that does to my child is they feels embarrassed. They feel like 'I'm nothing because everyone else is talking about us again'."

Orsborn said online services could provide an alternative source of support in situations where people were reluctant to seek help locally.

Orsborn said continued efforts were needed to improve mental health outcomes for rangatahi and Māori. 

Her hope was progress would continue to be supported by the Government's mental health and wellbeing strategy, due later this year. 

Within communities, a better understanding of clients' needs was important to ensure services reached people who need them most, she said. 

She encouraged whānau to have open conversations with one another to help identify concerns early. 

"It's about having the open conversations, supporting people, seeking help early and looking at the range of options that are available both locally, and other methods.

"Particularly for our young people who are more likely to connect into telehealth services or via text."