Good mental health is often taken for granted. Sometimes we don’t even realise we have a good state of mental health until all of a sudden we don’t. Many people in their lifetime, will struggle with some sort of mental illness. As a population group, Māori have on average the poorest health status of any ethnic group in New Zealand. Mental health in Maori is no exception and remains a very common problem. Poor mental health leads to poorer health in general. It affects social, spiritual, physical and mental health. There are a number of factors that contribute to this public health issue. Inequities in the social determinants of health are key here in assessing why poor mental health is pervasive in the Maori population. Social determinants of health are all interrelated and therefore it is imperative to evaluate the effects of one determinant of health on another determinant of health that ultimately leads to overall poorer health status, or in this case, mental health. To try and combat this issue there are a few policies, practices and initiatives in place such as Te Rau Matatini. From my own research I believe continuation of a strengths based approach in Heath Promoting Schools focussed on education around Maori mental health and, an increase in the number of Maori health promoters would be beneficial to Mental Health status amongst Maori.
Poor mental health in Maori people are amongst the highest rates in the developed world (Mental Health Commission, 2012). Unfortunately, when a person’s mental health is affected, so too are other dimensions of health. For example, studies show that a person who suffers from a mental illness is more likely to have physical health implications (Osborn, 2001). Maori cultures sees health as a four wall concept – the four walls being; Te taha wairua (spiritual wellbeing), Te taha hinengaro (mental wellbeing), Te taha tinana (physical wellbeing) and Te taha whanau (family wellbeing). This model of health is referred to as Te Whare Tapa Wha (Ellis and Collings, 1997). Using this framework, a person whose walls are all strong is representative of a healthy individual (Ellis and Collings, 1997). So when a Maori person has perceived poor mental health status, spiritual, physical and social health can also be affected.
There are other serious implications of poor mental health including suicide. Poor mental health status is positively correlated with instances of suicide (Compton, 2009). In 2002 the youth suicide rates (15-24 years) for Māori males and females were 43.7 and 18.8 respectively per 100,000 population, significantly higher than the non-Māori youth suicide rates (18.0 for males and 9.1 for females) (Supporting Families Organisation, n.d.). Evidently, poor mental health in Maori is a serious issue that has the ability to affect other dimensions of health and can ultimately lower overall health status and quality of life.
When examining risk factors for poor mental health in Maori, it is important to start off considering determinants of health. The social determinants of health are defined as “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness” (Wilkinson and Marmot, 2003). These circumstances are influenced further by other factors such as social policies, politics and economics. Wilkinson and Marmot (2003) lists; social gradient, early life, work, social support, food, stress, social exclusion, unemployment, addiction and transport as significant determinants of health.
Social gradient is one such determinant that plays a large role in determining the mental health of Maori. Social gradient reflects an individual’s or population’s position in society which is determined by socio-economic status (Wilkinson and Marmot, 2003). People living in unfavourable circumstances experience poorer health than people who have a better socio-economic status (Wilkinson and Marmot, 2003). In New