health & science

Pasifika’s widening mental health mis-match

By 2026, one in 10 New Zealanders is expected to be of Pacific Island descent. Teuila Fuatai reports that this increasingly youthful group faces worsening mental health problems and an unsuitable health system.

Auckland’s 100-bed Mason Clinic cares for some of New Zealand’s most mentally-ill violent offenders. About one-in-four of the patients detained there are of Pacific Island descent.

“That’s huge,” the clinic’s Samoan-born consultant psychiatrist Dr Lisi Petaia says. “Especially because we only make up about seven per cent of New Zealand’s population overall.”

That over-representation of Pacific people within forensic psychiatry services reflects a growing problem facing New Zealand’s mental health system – one which Petaia and a small cohort of Pacific mental health professionals are working to address. That problem is the significant mismatch between the mental health needs of an increasing, and notably youthful Pacific population, and the available mental health services.

A study published last year in the New Zealand Medical Journal examined suicides over a 17-year period. It showed Pacific people had the highest rate of suicide attempts, suicide plans and suicidal thoughts of all ethnic groups in New Zealand.

Pacific youth were also three times more likely to die by suicide than their European counterparts. And while Pacific suicides increased with deprivation, double the number of Pacific people living in the worst deprived conditions died by suicide compared to other New Zealanders with the same socioeconomic status.

One of the biggest problems is the rigidity of New Zealand’s mental health systems for Pacific people and their communities.

“Our way is the whole, extended family comes in and we expect everybody to contribute into this person’s mental problems."

- Dr Lisi Petaia

“You’ve got a system that is very embedded in European methodology – in the way they communicate and the way they treat people,” says Fuimaono Karl Pulotu-Endemann, whose 45-year career in mental health began as a trainee nurse at the former Oakley/Carrington psychiatric hospital.

For example, many Pacific people with mental health problems often do not receive treatment until they come to a hospital – when services can be – and need to be – accessed before this.

“It’s not as straightforward as saying people are not accessing services,” Pulotu-Endemann says.

“That is definitely one of the issues, but the problems are more than that because things have progressively worsened over the years. So I believe the workforce must be looked at.

“There needs to be a lot more culturally competent to deal with Pacific people, particularly because Pacific people often don’t seek out treatment for mental health problems.”

Newsroom spoke to Petaia and Pulotu-Endemann at last month’s annual general meeting of the Pacific Island Mental Health Professionals Association – a group which Petaia heads. It is designed to bring together the small, albeit growing number of Pacific individuals working in New Zealand’s mental health system. In doing so, the association – now in its third year – hopes to identify and promote mental health practises which work well for Pacific people.

“Our way is the whole, extended family comes in and we expect everybody to contribute into this person’s mental problems,” Petaia says, as Pulotu-Endemann – also born in Samoa – nods in agreement.

“That is totally different from the western/pālagi model which is individualistic in its way. It tends to emphasise that: ‘It’s my private life, and that I don’t want other people to be involved’. And that type of setup can be a real challenge when you’re dealing with family members who expect to provide support and be involved for someone that’s quite sick.”

Petaia joined the Mason Clinic from the Counties Manukau District Health Board about seven months ago. She says it’s difficult to navigate a more holistic approach often expected by Pacific people, in a system that doesn’t easily allow for it.

But she and Pulotu-Endeman report some positive developments over the years, despite negative statistics and ongoing challenges.

“When we first started, there really were no nurses or doctors [in the community], so what I did was train people who were very, very keen, and they were volunteers,” says Pulotu-Endemann, whose instrumental role in addressing mental health problems for Pacific people has led to him being affectionately referred to as the association’s kaumātua.

“They were family members who had had people who had mental illness. Slowly the nurses, and then the doctors came round.”

Petaia is also noticing a shift in the perceptiveness of the wider sector to more Pacific-friendly systems and treatments.

“What we’re seeing at the moment is very, very sad for Pacific people – because they tend to come in very late in the piece, untreated and complicated.

“But things are changing. A lot more people are aware of mental health now, which is quite powerful and that’s why more people are interested.”

Petaia and Pulotu-Endemann – who teach and mentor students in their respective professions – believe the association has a role in both encouraging more Pacific people into the mental health workforce and addressing cultural misunderstandings among their peers.

“The Pacific people are very predominant here,” Petaia says. “For instance, if you work in Auckland as a doctor – if you don’t understand the Pacific way of living – how are you going to manage your patients well?

“But more people are beginning to understand that the system isn’t designed for Pacific people. For example, I’m now teaching at Auckland [District Health Board] and at Otago University at registrar level, so all the consultants that are coming out… will have some understanding about Pacific history and Pacific families and how to deal with them.”

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Read more: Tackling the silence around Pacific youth suicide

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