Abstract

The major reforms in the New Zealand health sector during the 1990s resulted in a burgeoning in the numbers of Mäori health providers, many of who worked in the area of mental health. Occurring alongside these health reforms was an increased concern with public accountability and interest in measuring the performance of Crown agencies. During 2001–2004, research was undertaken that sought to understand the mental health contracting experience from the point of view of Mäori health providers. The research examined the experience of Mäori mental health providers as they contract to deliver Mäori mental health services in a health sector dominated by “Western” or mainstream approaches to accountability, contracting, and performance measurement. This article presents one of the key findings from this research: that Mäori mental health providers regularly and routinely work outside the scope of their contracts to deliver mental health services which are aligned with those values and norms enshrined in Mäori culture1. The types of additional burdens and responsibilities Mäori face in contracting for mental health services within a mainstream health system, as well as the reasons for these “extracontractual” activities, are discussed. The article concludes that in the New Zealand health sector a contracting framework—one which takes account of the unique role tikanga (customs, practices) and kawa (protocols) play in Mäori mental health service delivery—is required.