The Organizational Sustainability of Pacific Mental Health Services in New Zealand: What Influences Success?

Abstract

INTRODUCTION The growing burden of mental disorders in New Zealand as elsewhere is of particular concern to the health sector. In New Zealand, the over-representation of Pacific people in mental health statistics led to the establishment and growth of ethnic-specific services. Reforms and policy directives have changed the focus from growth to sustainability, without establishing a translational evidence-base that describes how organizational sustainability operates and is influenced in this context. An empirically grounded collective understanding of sustainability would provide services and stakeholders a common language base, thus, minimising ambiguities. This study sought to define organizational sustainability as it applied to the New Zealand Pacific mental health context and to develop a conceptual framework to help stakeholders identify the key factors that influence sustainability and are critical for success.

METHOD A methodological framework was developed, combining the key elements of talanoa (a Pacific approach to dialogue and engagement), strengths-approach and narrative analysis. In-depth, face-to-face interviews were conducted with thirty-one senior Pacific mental health providers, policy makers and academics. Observation notes and key documents supplemented the interviews. Three key narrative analysis techniques - thematic, structural and interactional - were used to analyse the data. The collective story of organizational sustainability was categorised via themes and examined in light of the research questions.

RESULTS Two conceptual frameworks for organizational sustainability were developed; one, embedded within a Pacific outrigger canoe image, while the second illustrated how the factors interacted. A guide to sustainability was also developed to translate the findings into a resource for services to address sustainability issues.

Participants sought to define organizational sustainability using their experiences and observations from the mental health sector. They struggled considerably with this task, raising concerns about the lack of dialogue in the sector. The reform environment within which the interviews occurred influenced participant definitions, thus, associating organizational sustainability with funding and performance reporting aspects.

The factors influencing sustainability were grouped in one of four categories: internal contextual factors, external contextual factors, over-arching factors and critical success factors. The internal factors were the Individual, the Team, the Leader, and the Organizational climate. Political and Financial factors comprised the external context. Culture, Hierarchies and Organizational Stigma were identified as the over-arching factors. The critical success factors were Effective communication, Shared values & beliefs, Stakeholder engagement & understanding, and Relationship strength.

CONCLUSIONS Reforms and policy directives are pushing New Zealand Pacific mental health services to demonstrate sustainability, and are perceived as threats to service delivery. At its core, sustainability concerns the ability of an organization to maintain its activities at a certain rate or level, and can only be achieved if the challenges are examined via a systems approach to understand the key factors and their influence on sustainability. This study acknowledges the collective story of those working in the sector. The results indicate a need for Pacific mental health services to build resilience and flexibility to mitigate ill-effects, and generate their own solutions, which are strongly embedded in the cultural values underpinning their identity to deliver sustainable services for generations to come.