'It absolutely needs to move out of that structure': Maori with bipolar disorder identify structural barriers and propose solutions to reform the New Zealand mental health system

Objectives This paper synthesises 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. Design A qualitative Kaupapa Maori Research methodology was used. Twenty-four semi-structured interviews were completed with Maori patients with BD 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 key themes identified the impact of structural features of the New Zealand mental health system on health equity for Maori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Maori patients and whanau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Maori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Maori with BD. Conclusion A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Maori patients with BD and their whanau.

Automated summary

This paper aims to identify barriers in the New Zealand mental health system for Maori patients with Bipolar Disorder (BD) and propose changes to improve its structure and function. The study used a qualitative Kaupapa Maori Research methodology, conducting semi-structured interviews with Maori patients with BD and their whanau. The findings highlight the impact of structural features of the health system on health equity for Maori with BD, and suggest potential changes to improve accessibility and scope of BD services for Maori.