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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