 A study revealing the true extent of mental health issues among Pacific people underlines the need for community-driven responses, says consultant psychiatrist Dr Siale ‘Alo Foliaki.
The Te Rau Hinengaro: The New Zealand Mental Health Survey was part of a World Health Organisation project exploring the prevalence of mental health disorders and the day-to-day burden on those who suffered from them. New Zealand was one of 28 countries involved. Dr Foliaki says a strength of the study was that it surveyed sufficiently large numbers of people to enable accurate analysis. Over 13,000 New Zealanders participated in the study and over 2,500 Pacific people were among the sample. “With those sorts of numbers, we could make very accurate statements about how many of those people had had suicidal thoughts or attempted suicide, how many were depressed or anxious or suffering from post-traumatic stress syndrome or had alcohol or drug problems,” says Dr Foliaki. There were three key findings in the report he says. “Historically, we’d always thought that Pacific people had low rates of mental health disorder because they had low levels of admissions to hospital. But the study found that was a fallacy. The level of mental health disorders among Pacific people was very high compared to mainstream New Zealand. Eighteen percent of the general population will experience a diagnosable mental health disorder, for Pacific people that figure was 24%. That was the main finding.”  Dr Siale 'Alo Foliaki “Poverty has an impact, unemployment has an impact on mental health disorders. We think the Pacific community is probably at most risk for worsening mental health problems because of its [low] socio-economic status.” The second major finding in the report was that Pacific people born in New Zealand had significantly higher rates of mental disorders than those born in the islands. “That speaks to something about growing up in New Zealand that either makes you more vulnerable to mental health problems or it decreases your resiliency. Even if you were born in the islands but came here as a child, the conditions here had an adverse impact on your mental health. People who had come to New Zealand after they were 18 years old had significantly fewer mental disorders, almost half the rate.” The other key finding was that the burden of mental health disease was mainly carried by young people and that among them there were high rates of suicide ideation and attempts. This too has huge implications for health providers. “If young people are carrying the greatest burden and the majority of the Pacific population is young – almost half is under 15 years old – then the country has a serious issue on its hands.” Dr Foliaki says the findings came as a surprise. “We weren’t expecting those results. There’s a migrant theory that says migrants and their children tend to do adequately and only if the second and third generations struggle to gain an economic foothold will the rates of mental health disorder trend upwards.” He says the scale of the problem is such that any meaningful response must be community driven. “A problem on this scale is a bit like the diabetes epidemic among Pacific people. It requires a response that can’t be provider driven. You can’t just provide more and more services as a solution to this problem. The solution has to be community driven. The Government is going to have to create frameworks that allow Pacific people to participate in their own health, take greater responsibility for it and be actively involved in it. “The Government has to start spending its money in a slightly different way because you can’t keep creating more psychiatrists as a solution to more young Pacific people wanting to commit suicide. What we need is early intervention from zero to six years of age. “Given certain conditions, we can accurately predict the life trajectories of a child age six and yet at present millions of dollars are going into interventions when people are 18,19 or 20. That’s far too late. Thirteen, 14 or 15 is probably too late. Maybe at eight, nine or ten years old, you’ve still got a chance. If you can identify at-risk families at a young age and invest in those people, then I think that’s where the solution lies.” What about treatment for those currently suffering? “I think if we did a better job of screening people when they had contact with the health system for mental health disorders then we could cope with the resources we’ve got, if they were directed more at the community end. We have enough medical and nursing staff and support services. Primary care is where we need to invest because that’s where our people are.”
Access to existing services was another key issue highlighted by the study says Dr Foliaki. “Six percent of Pacific people had severe mental disorders but the Mental Health Commission is funded to treat only three percent. The study showed that only one in four of Pacific people with severe mental disorders had visited a mainstream health practitioner, compared to over half of other New Zealanders. There is something about the way services are currently set up that doesn’t agree with our community, so that’s a big deal for us.” Dr Foliaki believes Pacific communities are ready to assume a greater role in the provision of services. “Yes, Pacific communities are up for it, but the Government needs to be prepared for it because community-oriented activities are time consuming and energy consuming. There are often conflicts and trying to maintain cohesion can be very demanding. But when you get those things right, it has a greater potential for better health outcomes than if you didn’t involve them. “So, there’s a price to pay involving the community and you have to put in sufficient money to organise things well in terms of governance. It can be difficult but it has to happen because the more disenfranchised and marginalised people are, the more likely they are to remain on the fringe and accountable to no-one.” Dr Foliaki is quick to add that there are also plenty of positive things happening in Pacific communities and we must be careful not to paint a misleading picture. “There are some real heroes and wonderful people in our communities. People living with dignity in difficult circumstances. "I want to convey a sense of optimism because there are things that can be done and there are lots of wonderful things happening.” He says there are a number of identifiable factors in mental health that can be changed. “You can dramatically reduce the problems facing Pacific adolescents, but each of those communities involved needs to take greater responsibility. It can’t be driven by Government or providers. It has to be the community, but that’s the one thing the Pacific community still has – a sense of community and social cohesion. We’ve got a window of opportunity to act while that social cohesion exists to organise those communities to take greater responsibility and make a difference.” Although it is a difficult area to work in, Dr Foliaki says the rewards are many. “It’s hard working in South Auckland and the problems can be really difficult, but my optimism is that every time you have contact with someone it’s like they’re standing at a railway station and the train keeps coming and they don’t get on. But with the right support and mentoring, my belief is one day they’ll get on that train. If you see them enough, if you’re prepared to hang in there, create systems that support people and provide continuity of care, at some stage people hop on that train and take their lives forward.” Te Rau Hinengaro: The New Zealand Mental health Survey The Ministry of Health published the first national survey of mental health in the New Zealand population in September 2006. The study has revealed that: - 47% of New Zealanders will experience a mental illness and/or an addiction at some time in their lives, with one in five people affected within one year.
- one in five (20.7%) of those people surveyed has experienced a mental disorder in the last 12 months.
- the lifetime risk (up to 75 years of age) of experiencing any common mental disorder such as depression, anxiety or an alcohol or drug disorder is 46.4%, namely nearly half of the population.
- mental disorder is common in New Zealand: 46.6% of the population are predicted to meet criteria for a disorder at some time in their lives, with 39.5% having already done
so and 20.7% having a disorder in the past 12 months.
- New Zealand has high prevalences of anxiety, mood and substance abuse disorders.
- younger people have a higher prevalence of disorder in the past 12 months and are more likely to report having ever had a disorder by any particular age.
- females have higher prevalences of anxiety disorder, major depression and eating disorders than males, whereas males have substantially higher prevalences for substance use disorders than females.
- prevalences are higher for people who are disadvantaged, whether measured by educational qualification, equivalised household income or using the small area index of deprivation.
- the prevalence of disorder in any period is higher for Ma¯ori and Pacific people than for the ‘Other’ composite ethnic group.
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