Assessment Of Needs And Values Vital To Providing Culturally Appropriate Care

The importance of providing culturally appropriate care was highlighted in a decision published by Deputy Health and Disability Commissioner Dr Vanessa Caldwell.

In her decision, Dr Caldwell found Te Whatu Ora - Counties Manukau (CM), formerly Counties Manukau District Health Board, in breach of the Code of Health and Disability Services Consumers’ Rights (the Code), for failing to consider and assess a woman’s cultural needs adequately, or provide her with services that took into account her cultural values and needs.

A Cook Islands Māori woman was referred to CM’s mental health services by her GP for severe anxiety. Tragically the woman died three months later having been found unconscious in her home.

The woman identified herself to CM staff as being Cook Islands Māori. Despite many opportunities for CM staff to consider culturally appropriate care for the woman over nearly three months, her cultural needs were not assessed and there was no discussion regarding options for culturally safe care specific to her needs.

Dr Caldwell noted that consideration of this case "focused on the lack of cultural support and the failure to obtain past clinical notes".

Under Right 1(3) of the Code, people have the right to be provided with services that take into account their needs, values, and beliefs of different cultural, religious, social, and ethnic groups.

Dr Caldwell was critical of the multiple failures by CM staff to consider and assess the woman’s cultural needs adequately. The woman was not informed about the cultural support options available to her, or offered any specific cultural support that met her needs.

"CM has a duty to provide care that takes into account the needs of different cultural groups. It must provide care that is culturally appropriate, in coordination with other services as required. … I consider that it is not sufficient for clinicians to simply acknowledge a person’s ethnic and cultural background, but that such information also needs to be considered appropriately for the provision of culturally safe care," said Dr Caldwell.

Dr Caldwell recommended that CM provide a written apology to the woman’s whānau for its breach of the Code; conduct an audit of 30 Pacific and Māori mental health and addiction service users from the last year and report the results back to HDC; and provide reports to HDC detailing analysis of the effectiveness of CM’s Pacific and Māori Cultural Liaison teams in meeting consumers’ cultural and health needs.

As a result of these events, CM’s Mental Health & Addiction service made multiple changes to the structure and delivery of its mental health services, including the creation of Pacific and Māori Cultural Liaison teams at the point of triage, to ensure appropriate cultural support and follow-up is provided from the beginning of an individual’s engagement with its services; and the development of an "Initial Psychiatric Assessment" guideline, which includes detailed discussion on the importance of culture in consumer care, and states that initial assessment will consider how an individual’s culture impacts their presentation and assessment process.

Notes

The full report of this case can be viewed on HDC’s website - see HDC's ' Latest Decisions'.

Names have been removed from the report to protect privacy of the individual involved in this case. We anticipate that the Commissioner will name DHBs and public hospitals found in breach of the Code unless it would not be in the public interest or would unfairly compromise the privacy interests of an individual provider or a consumer. HDC’s naming policy can be found on our website here.

HDC promotes and protects the rights of people using health and disability services as set out in the Code of Health and Disability Services Consumers' Rights (the Code).

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