Evaluation of Tu Meke PHO’s Wairua Tangata Programme: a primary mental health initiative for underserved communities

Abstract

BACKGROUND AND CONTEXT: New Zealand’s primary mental health initiatives (PMHIs) have successfully filled a health service gap and shown good outcomes for many presenting with mild to moderate anxiety/depression in primary health care settings. Maori have higher rates of mental health disorders and complexity of social and mental health needs not matched by access to PMHIs. ASSESSMENT OF PROBLEM: The Wairua Tangata Programme (WTP), a Hawkes Bay PMHI, aimed to provide an integrated, flexible, holistic, tikanga Maori–based therapeutic service targeting underserved Maori, Pacific and Quintile 5 populations. External evaluation of the programme provided formative and outcome feedback. RESULTS: The WTP reported high engagement of Maori (particularly women), low non-attendance rates, good improvements in mental health assessment exit scores, strong stakeholder support and service user gratitude. GPs reported willingness to explore mental health issues in this high needs population. Challenges included engaging Pacific peoples and males and recruiting from scarce Maori, Pacific and male therapist workforces. STRATEGIES FOR IMPROVEMENT: Effectively meeting the target population’s complex social and therapeutic needs required considerable programme flexibility, referral back into the programme and assistance with transitioning to other therapeutic or social support services. Referral criteria required adaptation to accommodate some sectors, especially youth. A group programme was developed specifically for males. LESSONS: A holistic PMHI programme delivered with considerable flexibility and a skilled, culturally fluent team working closely with primary care providers can successfully engage and benefit underserved Maori communities with complex social and mental health needs. Successful targeted programmes are integral to reducing mental health disparities. KEYWORDS: Primary health care; mental health; Maori; medically underserved areas; evaluation