Abstract
Background: Health inequities for Māori are prevalent in mental health, and Māori continue to have higher psychiatric hospitalisation rates than non-Māori. Pūkenga Atawhai (Māori mental health support workers) are required by their dedicated mental health service to be present with clinicians at the presentation of Māori mental health consumer's (tangata whaiora) and assist in addressing Māori health inequities. This research explores the experiences of Pūkenga Atawhai when working with Māori being admitted to a mental health unit.
Methods: To obtain the views of the Pūkenga Atawhai, a semi-structured focus group was arranged with 15 participants, and four individual semi-structured interviews were held with nurses. The discussion was guided by the research aim, and recorded and transcribed verbatim. The participants' comments were then analysed using thematic analysis.
Results: Three themes were identified that affect the engagement of the Pūkenga Atawhai when tangata whaiora and their whānau are admitted to an acute mental health service. The overarching finding was the need to address barriers in the health system that prevent the Pūkenga Atawhai from fulfilling their intended role. These barriers were first, cultural education gaps in the health system that would enable wider understanding of the Pūkenga Atawhai role, and its value for tangata whaiora. Second, there were frequent systemic issues in advising Pūkenga Atawhai of Māori patients' admission, therefore limiting the tangata whaiora access to the Pūkenga Atawhai. Third, there was no auditing process to assess staff cultural competency or other factors limiting the Pūkenga Atawhai ability to work in partnership with clinicians.
Discussion: The research contributed valuable and original insight into the barriers for Pūkenga Atawhai when tangata whaiora and their whānau are admitted to a psychiatric inpatient service, and highlighted that in order to address and improve Māori mental health inequities, there is a clear need to understand and address the present dichotomy between cultural and clinical practices.