Taking Account of Culture: The contracting experience of Māori mental health providers

Abstract

The major reforms in the New Zealand health sector during the 1990s resulted in a burgeoning in the numbers of Māori health providers, many of whom worked in the area of mental health. Occurring alongside these health reforms was an increased concern with public accountability and interest in measuring the performance of Crown (New Zealand Government) agencies. During 2001–2004, research was undertaken that sought to understand the mental health contracting experience from the point of view of Māori health providers. The research examined the experience of Māori mental health providers as they contract to deliver Māori mental health services in a health sector dominated by ‘Western’ or mainstream approaches to accountability, contracting, and performance measurement. This article presents one of the key findings from this research: that Māori mental health providers regularly and routinely work outside the scope of their contracts to deliver mental health services that are aligned with those values and norms enshrined in Māori culture.¹ The types of additional burdens and responsibilities Māori face in contracting for mental health services within a mainstream health system, as well as the reasons for these ‘extra-contractual’ activities, are discussed. The article concludes that in the New Zealand health sector a contracting framework—one that takes account of the unique role tikanga (customs, practices) and kawa (protocols) play in Māori mental health service delivery—is required.