Database of New Zealand mental health research

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Principal contact
Name	Dr Amohia Boulton
Email	amohia.whakauae@xtra.co.nz
The research
Summary	This research examines the experience of Māori mental health providers as they contract with the Crown to deliver mental health services. In doing so the research investigates performance monitoring systems and systems for accountability and highlights the complexity of delivering health and social services as conceptualised and implemented through a “western“ system to Māori communities.
Objectives	This thesis uses a theoretical framework devised specifically for this research to investigate the experience of Māori mental health providers as they contract to provide mental health services for the Crown; to ascertain whether Māori mental health providers deliver outside of their contracts; and to examine the role multiple accountabilities play in contracting.
Study design	The theoretical framework, the “Māori research paradigm net” is inclusive of both the kaupapa Māori and Māori centred approaches, moving beyond the traditional dichotomy that frames Māori health research and allowing the researcher the freedom to select and use the best and most appropriate research tools from both traditional social science research practices, and from Māori culture and tikanga, to answer the research question posed. Three types of qualitative data were collected: key informant interviews with policy-makers, academics, funders and planners of Māori mental health services; interviews with staff and Managers from seven Māori mental health providers (based in Tauranga, Manawatu, and Canterbury) and contract and performance monitoring documentation from these same providers.
Methods	Qualitative
Results	The research highlights a number of tensions in the Crown’s current approach to contracting with Māori health providers. In attempting to characterise the experience of these providers as they contract with the Crown the research found that: • Almost without exception, respondents reported that the current contracting system does not adequately capture the extent of the work done by Māori mental health providers, nor does that system adequately acknowledge or validate that work; • The contracts currently in use are regarded as narrow, inflexible, difficult to interpret and use, weighted towards clinical aspects of health care, without equal weight being given to cultural aspects, and unable to take account of the nature of the work Māori providers undertake in order to provide a service that is appropriate for the consumer; • While the Crown may view a contract as merely a mechanism by which two parties come to an agreement about the purchase and receipt of a set of services or products, for Māori the relationship that envelopes the contract is as important as the document itself; and • In spite of a “repeated commitment” to the Treaty of Waitangi principle of partnership, the unique aspects of Māori mental health service delivery which differentiate it from mainstream service delivery are not recognised or acknowledged in current contract documentation. In terms of performance measurement the research found that: • Māori health providers and the Crown view performance measurement in quite different ways. For the Crown performance measurement is concerned with accounting for where mental health dollars have been spent so that a judgement may be made on how wisely the money has been spent. Performance measurement occurs at a level removed from the consumer and is simply a mechanistic task of collating a series of indicators and reporting the results on a balance sheet; • By comparison performance measurement for Māori occurs at, and is viewed on, a very personal and intimate level. Māori mental health providers discuss performance measurement in terms of relationships, experiences and interactions with consumers and in terms of success with whānau, hapū, iwi and Māori communities (with whom the providers are often fundamentally tied); • The indicators contained in reporting templates are viewed by providers as having only limited utility, and as a consequence reporting is regarded as an exercise that must be performed in order to receive funding or secure a contract renewal; and • Māori mental health providers tend to focus on, and put their energies into, changes in consumers and in their lives, rather than on the indicators contained within standardised reporting templates. In essence it would appear that Māori mental health providers are using proxy outcome measures to gauge their own performance. With regard to accountability the research found that: • At any one time there are four major spheres of influence which exert pressure upon the provider and impact upon the provider’s work. These spheres are the consumer, the community, the Crown and indeed the provider themselves. Accountability arrangements between Māori providers, the Crown (as funder), the community and consumers are complex and multi-faceted and each sphere has their own agenda, desires and expectations which they attempt to see carried out by the provider; and • Fortuitously, for the most part, the competing expectations appear to be managed well by providers. However when competing expectations clash or where one sphere exerts more influence than another, providers may decide to step outside of their contract to meet these expectations or adjust their mode of service delivery. Where competing expectations are not managed, providers may actually fail to meet their contracted objectives.
Conclusions	The thesis concludes that Māori mental health providers deliver mental health services at the interface between two philosophical viewpoints or worldviews: that of the Māori community in which they are located and to whom they provide services; and that of the funder, from whom they obtain resources to enable them to deliver services. As a consequence of working at the interface, Māori providers regularly and routinely work outside the scope of their contracts to deliver mental health services which are aligned with those values and norms enshrined in Māori culture. To adequately acknowledge and validate the beneficial extra-contractual provision which occurs as a result of delivering mental health services at the interface, and prevent less desirable provision, a more responsive contracting environment and a performance measurement framework, which integrates both worldviews and which takes account of the multiple accountabilities that Māori providers manage, is required
Key Descriptors	Legislation & Policy, Service Development
Disciplines	Multi disciplinary
Settings	Community, NGO (Non Government Organisation)
Diagnostic Categories	General
Populations	General Population, Maori
Other Keywords	Health services research, public policy
Ethics approval	Yes
Academic led	Yes
Service led	No
How were service users involved	Participants of the research
Publication in peer review journal	Yes
Supporting information
Uploaded files	Abstract for Provision at the Interface: The Maori Mental Health Contracting Experience
Links

Page last updated: 7 November 2008