Culturally competent, safe and equitable clinical care for Ma over bar ori with bipolar disorder in New Zealand: The expert critique of Ma over bar ori patients and Wha over bar nau

Objective: Research designed to increase knowledge about Maori with bipolar disorder is required to understand how health services support wellbeing and respond to identified levels of community need. This paper synthesises the expert critique of Maori patients with bipolar disorder and their whanau regarding the nuances of cultural competence and safety in clinical encounters with the health system. Methods: A qualitative Kaupapa Maori Research methodology was used. A total of 24 semi-structured interviews were completed with Maori patients with bipolar disorder and members of their whanau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Results: Three themes were evident from participants' critique of clinical components of the health system. Theme 1 established that the efficacy of clinical care for bipolar disorder was dependent on Maori patients and whanau having clear pathways through care, and being able to access timely, consistent care from clinically and culturally competent staff. Theme 2 identified the influence of clinical culture in bipolar disorder services, embedded into care settings, expressed by staff, affecting the safety of clinical care for Maori. Theme 3 focused on the need for bipolar disorder services to prioritise clinical work with whanau, equip staff with skills to facilitate engagement and tailor care with resources to enhance whanau as well as patient wellbeing. Conclusion: The standard of clinical care for Maori with bipolar disorder in New Zealand does not align with practice guidelines, Maori models of health or clinical frameworks designed to inform treatment and address systemic barriers to equity. Research also needs to explore the role of structural and organisational features of the health system on Maori patient and whanau experiences of care.

Automated summary

This study explores the clinical care situation of Maori with bipolar disorder using a qualitative research method. Findings indicate that cultural competence and safety are important concerns in clinical care for Maori patients and their families. Patients and families believe that the effectiveness of clinical care depends on clear pathways, timely and consistent care, and support from clinically and culturally competent staff.