1.1.

2 Pacific Mental Health in New Zealand and Pacific Mental Health Services Mental disorders are recognised by the New Zealand Government and the WHO as maj or public health issues. Unlike western understandings of mental disorders, Paci fic peoples generally do not consider mental illness to be a disorder that necessa rily originates only from within a 1 Pacific people describes the wide variety of people living in New Zealand who ha ve migrated from the Pacific Islands or who identify with the Pacific Islands be cause of ancestry or heritage. The term encompasses a range of ethnic, national, language and cultural groupings. It also includes smaller concentrations of peo ple from the Melanesian (namely Papua New Guinea, Vanuatu and the Solomon Island s) and Micronesian islands (mainly from Kiribati) (Bathgate et al, 1994). Introd uction 1 person (Bathgate and Pulotu-Endemann, 1997: 106). Rather, as various Pacific hea lth practitioners and researchers (Maiai, 1997; Tamasese et al, 1997; Crawley et a l, 1995; Anae, 1998) have suggested over time, Pacific peoples often view mental disorder as spiritual possession that is usually caused through the breach of a s acred covenant between peoples or between peoples and their gods. The traditiona l approach to healing such mental disorders is, therefore, to seek the input of traditional healers believed to have the spiritual powers necessary to restore t he spiritual balance upset by the possessed person or someone close to them. Such beliefs about mental health and traditional healing are common to many other non -western indigenous peoples (e.g. Native Americans and Hawaiians, see Bird et al , 2002). These beliefs and practices continue to be held and exercised by many P acific peoples living in New Zealand today. In the mid 1980s Pacific peoples with mental health disorders were recorded as b eing more likely to be committed to psychiatric care than Mori or other New Zeala nders (Bridgman, 1996). This was read however as arising because Pacific peoples presented at much later stages of mental illness than the others (Malo, 2000). Accessing mental health services was for Pacific peoples done mainly, according to anecdotal evidence, at severe points of crisis. Often mental health services were only accessed because the Pacific consumer was referred to a mental health service through a statutory agent (i.e. the Police or DSW or hospital) (Chaplow, 1993). Until the consumer presented him or herself to a mental health service t he extent of the burden of his or her mental illness on his or her family was un known. Pacific peoples suggest that the main reasons for late or mandatory prese ntations involved issues of shame or pride (Ieremia, 2003). Mental health services in New Zealand have traditionally been very monocultural in all aspects of service delivery. It has only been in the last ten years or so since the deinstitutionalisation of mental health services and the greater advo cacy by Mori, that mental health services in New Zealand have begun to realise th e significance of culture in mental health. This greater awareness and growing s ensitivity to the impact of culture in the presentation, assessment and treatmen t of serious mental disorders has led to the recognition of the need for cultura lly appropriate services. Funding of culturally appropriate support services and clinical services for Mori (and more recently Pacific peoples) is therefore a re latively recent phenomenon. With regards to mental health care it is estimated that central Auckland provide s care for the greatest number of mentally ill Pacific peoples within the ADHB c atchment area. Other New Zealand areas of high Pacific population density are Ma nukau City, Wellington, Waikato and Canterbury. Most Pacific mental health services in New Zealand today are provided in the com munity. This is evidenced by the fact that the Pacific mental health services ex penditure for 2001/2002 show that the community/residential services for combined ages group took 69% of its budget. This includes Pacific DHB community-based and NGO community mental health services. Foliakis (2001) recent work suggests that because of the low socio-economic statu s of Pacific peoples in New Zealand society and because of their high risk repre sentations in general population and health statistics, their vulnerability to m ental health stressors and/or developing severe mental health disorders is high. There is therefore a need to perform robust research in order to build quality

research data to have better understanding of Pacific mental health issues and t o find ways of appropriately servicing