Barriers and Supports Pacific People Experience In Using Mental Health Services

Abstract

Pacific people comprise approximately 7% of the total New Zealand population and with their higher birth rates this percentage is expected to increase in the foreseeable future. Pacific people in New Zealand experience mental disorders at higher prevalence rates than the general population and are also less likely to have accessed mental health services for their mental health problems compared with other ethnic groups in New Zealand. This study investigates the underutilisation of mental health services by Pacific people and the experiences that hinder or support their access and use of mental health services. Interviews were conducted with: 10 service providers (6 of Samoan descent and 4 of Tongan descent); 11 ex-service users (9 of Samoan descent, 1 of Tongan descent and 1 of Niuean descent); and four service providers participants who were also ex-service users (3 of Samoan descent and 1 of Tongan descent); to gain insight into their perceptions and experiences of barriers and supports for service use. The data were analysed using a process of thematic analysis. In relation to barriers that Pacific people face in accessing and using services, there were two categories of themes. The three themes in the first category: Barriers to Accessing Services were Shame, Stigma and Fear; Lack of Knowledge; and Limited Relevance of Services . The four themes of the second category were: Lack of Cultural Understanding; Barriers in the Therapeutic Relationship; Other Barriers in Therapeutic Practice and Socio-economic Barriers. Three themes emerged in relation to the supports that assisted Pacific people to access and use services. These themes were: Supports in Accessing Services, Positive Therapeutic Relationships, Family Involvement and Service Support for Family, Other Cultural Support in Services, and Other Supports in Using Services. The experiences of stigma, shame and fear; lack of knowledge about mental unwellness symptoms and services; and lack of belief in the usefulness of services appeared to underlie Pacific people's lack of approach to services and could lead to more severe presentations when they eventually entered services. These results also suggest that some Pacific people experience a lack of cultural understanding and support from services. Service providers from mainly western backgrounds were seen as sometimes having limited understanding of the socio-cultural contexts of Pacific service users and their families that impacted on practices in therapeutic relationships, assessment and therapeutic processes. This was particularly relevant in understanding the collectivist and holistic cultural values and practices of Pacific people; the acculturation and identity related challenges; and socioeconomic difficulties that might feature in Pacific service users' presenting problems. A number of supports were identified that assisted Pacific people to approach and use services more effectively. In accessing services, these included service users drawing on personal strengths; the support of family and friends; and having knowledge of mental unwellness symptoms and services. In using services, positive therapeutic relationships with particular attention to rapport-building based on Pacific approaches were experienced as being helpful. The Pacific service providers and service users who were interviewed emphasized the importance of effective socio-cultural training for staff. They also emphasized the importance of effective psychoeducation for Pacific service users and their families. The implications for mental health services are discussed, along with the limitations of the study, and future research directions.