Te Pūmanawa Hauora Research Centre for Māori Health and Development Contracting Issues for Providers of Māori Mental Health Services: Findings from Recent Research Te Mata o te Tau Seminar Series 30 March March 2006

Te Pūmanawa Hauora Research Centre for Māori Health and Development Background Emerging concern with outcomes and accountability in the public sector Master of Arts (Applied) in Social Science Research which evaluated a Mäori Men’s Wellbeing Programme Recognition by the Health Research Council that more research was required in the area of mental health

Te Pūmanawa Hauora Research Centre for Māori Health and Development Research Aims Three broad research questions what is the experience of Māori mental health providers in contracting to provide mental health services for the Crown? do Māori mental health providers deliver outside of their contracts? what role do multiple accountabilities play in the contracting environment?

Te Pūmanawa Hauora Research Centre for Māori Health and Development Methods Māori-centred approach Qualitative methods Face to face interviews with two types of informant Key informants (20) Māori mental health providers (15 staff in 7 providers) Analysis of contract and performance monitoring documents

Te Pūmanawa Hauora Research Centre for Māori Health and Development Findings Both performance measures and contracts themselves were deemed inadequate generic,dated, narrow, inflexible, difficult to interpret and use, unable to take account of the nature of the work Māori mental health providers undertake in order to treat tangata whaiora Extra-contractual work is regularly and routinely undertaken

Te Pūmanawa Hauora Research Centre for Māori Health and Development Findings Reasons for the extra-contractual work include: Worldview –Being governed by tikanga –The use of hauora practices –The adoption of a holistic approach –A focus on whānau ora

Te Pūmanawa Hauora Research Centre for Māori Health and Development Findings Reasons for the extra-contractual work include: Strategic Development Community Expectation or Need Service Equity Overstating Capacity and/or Inexperience or Immaturity Passion

Te Pūmanawa Hauora Research Centre for Māori Health and Development Findings Contracts are entered into with very different expectations – for Māori the relationship is as important as the contract Māori and the Crown judge and measure performance in different ways Providers are able to demonstrate changes in health status, but this information is not captured or is ignored

Te Pūmanawa Hauora Research Centre for Māori Health and Development Conclusions Difference in worldview exists – reconciling mainstream contract performance measures with “Māori aspirations for an integrated approach to social, cultural and economic development” (M. H. Durie: 2005:177) Mismatch exists between strategic policy, operational policy and provision

Te Pūmanawa Hauora Research Centre for Māori Health and Development Policy Implications Are we funding the right services, in the right way, at the right amount? A range of unintended but not wholly unwanted outcomes have resulted “Resource shifting” by providers occurs Providers “compete” with DHBs

Te Pūmanawa Hauora Research Centre for Māori Health and Development Policy Implications Changes to structures, systems and processes appear necessary Improving the relationship between DHBs and community- based providers is crucial Recognition of a further set of accountabilities is required

Te Pūmanawa Hauora Research Centre for Māori Health and Development Acknowledgements Funding for the Project from a number of sources: HRC Training Fellowship and Strategic Project Grant Māori Student Scholarships from the Ministry of Health, Social Policy Agency and the Māori Education Foundation Ngā Pae o Te Māramatanga Scholarship Support and Co-Supervision from the Health Services Research Centre The Participants

Te Pūmanawa Hauora Research Centre for Māori Health and Development Contact Details Amohia Boulton Te Pūmanawa Hauora Research Centre for Mäori Health and Development Massey University P O Box Palmerston North New Zealand