This report is an independent review of the health and social needs of Chatham Islanders.
The Ministry of Health commissioned a report on the health and social needs of Chatham Islands. Māori Community Services intends to use the report to guide their work based on the aspirations and realities of whānau/families living on Chatham Islands.
Chatham Island has a good core of health and social services. The strengths of the services on Chatham Island are acknowledged. Further needs identified by whānau/families, together with considerations for moving forward, are set out below.
Maintaining and enhancing primary health care
Free primary health care and free prescriptions are important enablers for whānau/families living on Chatham Island to access and maintain health and wellbeing. For those living on Pitt Island, there is a need to enhance access to primary health care with annual or twice yearly visits by the GP and nurses, as well as linking to other service providers on Chatham Island (eg, Māori Community Services). Pitt Island whānau/families have also proposed a local solution: the part-time employment of a nurse living on the island.
Chatham Islands Health Centre has an important role in strengthening whānau/family health and wellbeing. Consideration is needed on the service delivery model used by Chatham Islands Health Centre, in particular ensuring the service is whānau/family-centred, culturally competent and integrated with other service providers.Three key needs
Three key needs have been identified by the community to strengthen whānau/families’ health and wellbeing:
- ongoing improvements to housing stock
- earlier and more effective response to mental health, alcohol and drug addictions and behavioural issues: Evidence shows that responding earlier and more effectively can improve people’s lives, avoid negative impacts on society and reduce the level and intensity of demand for services arising later (Fonagy et al 2000; Merry et al 2008). The Mental Health Commission (2012) advocates a life course approach to enable early intervention from across the whole of the health sector and broader social, education and justice sectors, as well as the mental health and addition sector. Consideration is needed as to how this framework can be applied effectively on a remote island.
(The community is seeking more consistent and regular access to counselling services. Further consideration is needed to determine the most effective intervention for whānau/families living on Chatham Islands.)
- consistent and effective response and interventions for family violence, via an interagency and community approach: Fanslow and Robinson (2010) highlight that family violence is not necessarily a ‘private problem’, and that women are seeking help. However, the responses they receive from their informal support networks and institutions tend not to be helpful. Fanslow and Robinson recommend a broader community outreach approach to ensure whānau/family and friends are able to provide appropriate support for women in abusive relationships.
Te Puni Kōkiri suggests that kaupapa Māori approaches are required to address family violence from a Māori worldview, structured using Māori tikanga approaches (Te Puni Kōkiri 2010; Te Puni Kōkiri 2010a). On Chatham Islands, possible programmes and responses to family violence need to consider using models based on a kaupapa Māori framework and inviting input from across whānau, hapū, iwi and Māori communities to intervene and transform current experiences. This approach recognises that whakapapa and whānau are central to relationships (Te Puni Kōkiri 2010).
In determining appropriate responses and strategies for Chatham Islands, consideration of the existing evidence base is recommended to identify effective practices both to enable and support victims of family violence and to offer/enforce interventions for perpetrators (eg, anger management courses).