Institutional pathways to psychosis for Indigenous Māori: A qualitative exploration of experiences

Background Inequities in the incidence and outcomes of first episode psychosis (FEP) for Indigenous peoples are impacted by multiple institutional systems. This study examines Indigenous experiences of these systems to gain an understanding of how to improve institutional responses to FEP inequity. Methods Critical race theory informed the methods used. Twenty-three participants participated in four focus group interviews, and thirteen individual interviews, including nine Māori youth and young adults with FEP, ten family members, and four Māori health professionals. Participants were asked about lifetime experiences of institutions (health, social, and criminal-justice). An adapted WHO framework for addressing mental health inequities was used to organize and analyse the first round of structural coding, followed by descriptive and pattern coding. Results Two themes were identified. The first theme signposted opportunities for institutional intervention. Participants critique being processed quickly through institutions that are driven by socio-political agendas, namely perceived risk, threat or crisis. Subsequently, opportunities for meaningful intervention were missed. The second theme identified scope for family orientated responses across sectors. Participants described short-term social interventions and institutional structures that focused on individuals rather than families, emphasizing the need to broaden cross-sector scope to structural interventions for families. Discussion The findings highlight institutional responses are focused on organisational drivers and downstream issues, that fail to address the fabric of the family social-environmental conditions that maintain Indigenous exposure to psychosis risk and poor outcomes. A pathway to equity would require a shared framework of social responsibility across sectors, that targets structural factors responsive to Indigenous family needs.