Foundations of integration

Under Te Tiriti o Waitangi everyone working to support health and wellbeing shares responsibility with iwi, hapū and whānau to contribute towards oranga and whānau ora for Māori people as tangata whenua.

In demonstrating a commitment to Te Tiriti this guidance seeks to:

• Support practice that upholds the significance of te reo Māori, te o Māori and Māori models of practice, as outlined for example in Real Skill: Working with Māori, in Let’s get real: Real Skills for working with people and whānau who have mental health and addiction needs.
• Acknowledge and learn from the work of Māori organisations providing integrated approaches and where possible contribute to further development of these.
• Contribute towards development of a Māori responsive workforce working within an integrated approach in primary and community health settings.

The Aotearoa New Zealand Government vision for health and social care is equity for all. Health equity is achieved when everyone has a fair opportunity to achieve their full health potential.

The Ministry of Health defines equity as follows:

In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.

In New Zealand, Māori and Pasifika peoples are among those who experience the most disadvantage and are therefore identified by the Ministry of Health as high priority populations for addressing health equity (Ministry of Health, 2019). Under Te Tiriti o Waitangi Māori have rights to have their health protected. For Pasifika peoples, the Ministry of Health has set a clear agenda to support Pasifika health and wellbeing in Ola Manuia: Pacific Health and Wellbeing Action Plan 2020–2025 (Ministry of Health 2020).

Developing and strengthening effective integrated primary and community health and social services is one strategy for addressing inequity. It is intended that Māori and Pasifika peoples will experience better health outcomes when services are more easily accessed, better connected and address social and cultural determinants of health – features which are central to an integrated approach.

When applying an equity lens, provision of an integrated approach requires meaningful engagement with Māori and Pasifika (and other minority and/or disadvantaged communities) to understand their aspirations, worldviews and needs. It also requires a focus on developing the workforce to ensure culturally safe practice, elimination of racism and discrimination, and integration of cultural values, practices and concepts into health care.

Guidance on key actions to achieve equitable health care for Māori for health organisations (such as DHBs, PHOs and other health providers), health workers (such as doctors, nurses and community health workers) and the health system (such as Ministry of Health) is outlined in: Equity of Health Care for Māori: A framework.

Let’s get real: Real Skills for working with people and whānau who have mental health and addiction needs outlines the values, attitudes and foundational skills for everyone working in health to work effectively in partnership with people and whānau with mental health and addiction needs.

Let’s get real provides a well-established framework that offers an effective foundation for working within an integrated approach. It comprises values, attitudes and 7 Real Skills, co-developed by people with lived experience of mental health and addiction needs and people working in health services.

Detailed information and resources to support learning and implementation of Let’s get real are available here.

The expectation is that an effective integrated approach would include the foundation of Let’s get real values, attitudes and skills and additional specific skills for integration.

The relationship between Let’s get real and the three specific skills for integration is shown in the image below.

Shared values, attitudes and skills for working within an integrated approach

The shared nature of the Let’s get real framework makes it particularly effective in supporting an integrated approach.

In using Let’s get real as a foundation for integration, the aim is not to replace organisation-or professional specific values and competencies, but to reflect the shared values, attitudes and skills that apply to all of the workforce, across all health settings and regardless of organisation, role or profession.