Achieving equitable mental wellbeing for Māori and Pasifika youth

-INSIGHT-

Rochelle Menzies[1]

 

The world has changed significantly in recent decades, meaning contemporary youth are experiencing life in ways never encountered by previous generations. In this fast-changing world, younger generations face a myriad of challenges to their mental wellbeing, with youth from Indigenous, disadvantaged and minority groups persistently at the highest risk of poor mental health outcomes. Adding to the stressors burdening our young people, the COVID-19 pandemic has generated school closures, social isolation, repeated disruptions, and uncertainty around the future. With disadvantaged communities disproportionately impacted, concerns are growing around the mental wellbeing of Māori and Pasifika youth.

The World Health Organization has expressed concern that globally youth are increasingly experiencing poor mental health. Not only do contemporary youth experience lower levels of mental wellbeing, but they have comparably high risks of self-harm, addictions, mental illness, and suicide. Mirroring these trends, He Ara Oranga reported high levels of distress, self-harm, risk-taking, and anxiety disorders among children and youth in Aotearoa New Zealand as well as our ‘national shame’ – youth suicide rates. Worth special mention is the very high rates of mental morbidity amongst ‘Rainbow’ youth, which are of particular concern. This essay will focus on the declining mental wellbeing and persistently poor mental health outcomes experienced by Māori and Pasifika youth – a number of whom will also belong to the Rainbow community.

In recent years, reports have highlighted the disproportionate mental health risks and mental illness prevalence amongst young Māori. Te Oranga Hinengaro found rangatahi Māori aged 15-24 years were significantly more likely than any other age group to report feeling unable to cope with daily life stressors.  A Waitangi Tribunal report (Walker, 2019) found Māori consistently have the highest addiction risk related to alcohol, tobacco and other substances, with rangatahi Māori reported to have higher rates of tobacco use and hazardous drinking than their non-Māori peers. Another Waitangi Tribunal report on Māori Mental Health (Gassin, 2019) revealed young people aged 15-24 years had the highest suicide mortality rates, but Māori males within this age group with the highest total rate of suicide.

Similarly, statistics reveal Pasifika youth mental health and wellbeing are comparable to Māori. Te Rau Hinengaro reported that young Pacific persons have increased risks of serious mental disorders and suicidality compared to their Pākehā counterparts, and were also least likely to benefit from mental health services. The 2018 Te Kaveinga report revealed 25% of Pacific peoples reported moderate levels of psychological distress in the previous month, and 5% high levels,  with prevalence highest amongst older adults and 15-24-year-old youths.

Concerning mental health trends amongst Year 9-13 students have been recently highlighted by Youth19 survey data. Māori report worse mental health overall than Pasifika youth, but both are worse than their Pākehā peers. Both Māori (13%) and Pasifika (12%) youth are four times more likely to attempt suicide than Pākehā (3%). Overall Māori rates of depression and suicidality have doubled from 2012-2019, and rates reflect a social gradient; for example, Māori living in medium-high deprivation households are twice as likely to attempt suicide than those in low deprivation. A similar social gradient is apparent for Pasifika youth, with those in high deprivation situations seven times more likely to attempt suicide than those from low deprivation households. Pasifika males’ suicidality rate had tripled between 2012-2019 to 10%, which is a particularly concerning trend.

However, among the youth surveyed, it was Māori females (17%) who had the highest rate of attempted suicide, nearly twice the rate of Māori males (9%). Other gender-based trends in mental health are apparent amongst Māori and Pasifika youth. For instance, females from both groups are less likely to report good wellbeing and more likely to attempt suicide than males. Moreover, Māori (38%) and Pasifika (33%) females were twice as likely to experience significant depressive symptoms than males, at 19% and 15% respectively. Apparent inequities highlighted by these Youth19 findings in relation to ethnicity, gender and socioeconomic status suggest deeper investigation is warranted.

Insightful findings from Youthline 2020 – The State of the Generation elucidate key areas of concern according to Māori and Pasifika youths (16-24 yrs) surveyed. When asked about the biggest issues facing youth, they identified the following: 1. Mental health issues (72%), 2. Suicide (69%), 3. Drugs (66%), 4. Depression (64%), and 5. Anxiety (63%). Key stressors for Māori and Pasifika youth were education pressures (63%) and stress around employment (29%) compared to all other youth (31% and 15% respectively). They were also more likely to mention issues around suicide, drugs and gangs as well as seek help with these, than all other youth.

According to the Prime Minister’s Chief Science Advisor 2017 paper on youth suicide, multiple factors are implicated in young people’s mental health outcomes, yet little is known about specific determinants driving poor mental health among Māori and Pasifika youth. There is an urgent need to better understand contemporary factors at play in the mental wellbeing of these young people. For example, parenting practices have changed significantly from more traditional ways of raising children within extended families towards more detached parenting styles within nuclear family structures. The implications of these changes are not well understood. The digital era alone has ushered in a plethora of unprecedented challenges for youth. Social media, digital devices, internet (mis)information and online communication have introduced a range of new harms that youth must navigate during the most turbulent years of their life. Meanwhile, parents lack the wisdom of lived experience needed to successfully guide children through the unprecedented contemporary conditions, which are increasingly challenging youth mental wellbeing, as reported last year.

There are some key similarities between Māori and Pasifika populations around demography, cultural diversity, and socioeconomic disadvantage that are pertinent to understanding mental wellbeing for these youths. Both cultural groups have extremely young population profiles in comparison to non-Māori and non-Pasifika peoples. The 2018 national statistics report population totals as 766,000 for Māori and 390,000 for Pasifika peoples, with over 50% of both populations aged 25 years or less. This carries implications regarding the large proportion of these populations who are vulnerable children and youth potentially impacted by circumstances and events beyond their control that negatively impact mental health. Furthermore, the disproportionately high rates of mental illness and suicide amongst Māori and Pasifika youth are all the more alarming considering the youthfulness and size of these minority populations.

Similarly, the Mental Health Inquiry – Pacific Report identified both Māori and Pasifika populations as experiencing increasing ethnic and cultural diversity, which speaks to a shifting culture-scape around identity for multiethnic, culturally-diverse youth.  Te Oranga Hinengaro noted positive cultural identity is critical for overall health and wellbeing of Indigenous and minority peoples, and also plays an important role around willingness to access health services and treatments. The significant ethnic overlap between Māori and Pasifika populations is not well understood in terms of cultural identity, and potentially identity conflict. Effects of increasing multiculturalism within Aotearoa New Zealand society also exposes our youth to lifestyles and social norms that often conflict with traditional cultural ways of knowing and being, potentially confusing or undermining the cultural identity of these minority youth further.

Socioeconomic disadvantage is another demographic trend common to Māori and Pasifika peoples, with persistently high levels of deprivation and marginalisation experienced by these highly-urban populations. Over 60% of the Pasifika population and 25% of the Māori population reside in Auckland, but they are predominantly located in concentrated areas of high deprivation within the wider region. Bearing the burden of socioeconomic disadvantage, nationally 40% of Māori and over 50% of all Pasifika peoples live in areas of most deprivation, i.e. deciles 9 and 10.

The implications of intergenerational disadvantage in increasing the propensity for mental health concerns in young people can be understood from the perspective of how executive function and emotional regulation develops – a point of focus for Koi Tū’s ongoing work.  He Ara Oranga highlighted the strong association between poverty and poor mental health outcomes, which speaks to the high rates of poor mental health amongst Māori and Pasifika peoples, while highlighting the need to address poverty within these populations to promote greater wellbeing. Unfortunately, exacerbating the longstanding socioeconomic disadvantage of Māori and Pasifika peoples, the current pandemic adds to the mental health burdens already experienced. Large portions of these populations reside in South Auckland, where the impacts of COVID-19 have hit households very hard.

For instance, iwi research by Ngāti Whātua Ōrākei found the 2020 national lockdown in Aotearoa New Zealand presented significant challenges for many Māori youth around remote learning, and exacerbated existing inequities within the education system. The resulting report highlighted the digital divides currently experienced by whānau Māori and other disadvantaged groups, including Pasifika families, that made online learning extremely difficult for many children and youth. Lack of equitable access to appropriate digital devices and adequate internet connectivity for school students from disadvantaged households has reportedly lead to additional worry, anxiety and stress amongst Māori and Pasifika youths.

Confirming this, school principals reported huge inequities within the education system, mainly around digital access for remote learning and families’ capacity to support learning during school closures. Principals also reported high numbers of senior students ‘falling through the cracks’ around the national lockdown period, disengaged from remote learning and dropping out of schools. As the pandemic persists, it is likely the majority of students dropping out will be Māori and Pasifika from low-decile schools, who will face ongoing challenges around employment and low income, potentially leading to lifelong disadvantage. For remaining students, principals are concerned about unknown impacts of lockdown on learning progress, educational achievements, and students’ mental wellbeing that will need to be addressed sufficiently, as a matter of urgency.

In 2020, the Koi Tū mental health expert advisory group forewarned of COVID-related impacts likely to be experienced by vulnerable young persons over the next ten years. More specifically, job losses, increased poverty rates, and decreased work opportunities are predicted to negatively impact many already-disadvantaged youth, exacerbating intergenerational disadvantage and vulnerabilities towards poor mental health. Unfortunately, there is a very real risk that Māori and Pasifika youth needing mental health support or services will not receive effective or timely help.

Youthline 2020 identified the main barriers to Māori and Pasifika youth seeking help as: being embarrassed (67%), not wanting to be judged (64%), and not wanting to talk about problems (59%). They were also unlikely to seek help if they perceived support lacked confidentiality, caring, and cultural responsiveness or acceptability. Unfortunately, they are less likely to have someone to support them, with only 7% having a support network (someone to talk to) compared to 23% of all youth. Of the youth surveyed, Māori and Pasifika 16-17-year-olds were less likely to feel that the community views youth positively, which when combined with barriers to seeking support, might play some role in the rising suicide rates among these teenagers.

However, Youthline 2020 responses do shed some light on ways to better meet the mental health needs of Māori and Pasifika youth.  Recommendations to lower the suicide rates include: reducing negative impacts of social media, removing the stigma around mental health, and empowering children (and equipping schools) with tools to manage stress and self-care. The best support for Māori and Pasifika youth was identified as: youth mentoring (66%), youth groups (61%), and information leaflets (38%). Key characteristics these youth prefer in a support person included: someone who is non-judgmental (89%), who listens well (81%), who is trustworthy (77%), who is available to talk to more than once (73%), and who is relatable (70%).

Clearly, now is the time to develop and implement youth-responsive and culturally-specific services and support based in schools and communities to promote greater mental wellbeing within Māori and Pasifika youth populations. This speaks to an urgent need for extensive flaxroots research with Māori and Pasifika youth, their families, and communities to better understand what these youth need to be mentally well and stay well. Further, consultation and co-design with iwi, cultural leaders and key stakeholders is needed for policy and practice that better protects and promotes the mental wellbeing of Māori and Pasifika youth in culturally-responsive and sustainable ways.


[1] Rochelle Menzies is of Te Aitanga-a-Māhaki and Ngāti Kahungunu descent and joined Koi Tū as a Kaupapa Māori research fellow. Near completion of her PhD in Health Sciences, her doctoral research focused on contemporary conceptualisations of whānau wellness from the perspective of urban adult Māori living in Aotearoa New Zealand.

Rochelle was previously Research Fellow at Koi Tū: The Centre for Informed Futures, and is now Senior Advisor Māori at the Suicide Prevention Office, Ministry of Health (Mental Health & Addiction).