The appropriateness of DUNDRUM-3 and DUNDRUM-4 for Māori in forensic mental health services in New Zealand: participatory action research

BACKGROUND: The Auckland Regional Forensic Psychiatry Services (ARFPS) in New Zealand has introduced structured clinical judgment instruments developed in Ireland (DUNDRUM-3 and DUNDRUM-4) to assist staff decision-making regarding service users’ clinical pathways. In New Zealand, Māori (the indigenous people) constitute 43% of the in-patient forensic mental health population. The aim of this study was to determine the face validity of the measures for Māori. METHODS: Participatory Action Research was aligned with a kaupapa Māori (Māori-orientated) research approach, to give full recognition to Māori cultural values. Two hui (gatherings) were held with Māori clinical and cultural experts at the service. The first hui (n = 12), explored the cultural appropriateness of the measures. The second (n = 10) involved a reflection on appropriate adaptions to the measures. Discussions were digitally recorded, transcribed and thematically analysed. RESULTS: Although the usefulness of the measures in enhancing the overall quality of clinical decision-making was confirmed, the DUNDRUM measures were considered to be limited in their ability to fully measure Māori service user progress and recovery. Suggestions were made to develop an additional ‘pillar’ focused on cultural identity and spirituality for DUNDRUM-3; to use both service user and family ratings for the adapted DUNDRUM-3 and DUNDRUM-4 measures; and to involve cultural expertise at the point of structured clinical judgement when using the measures. CONCLUSIONS: This is the first study to consider the face validity of the DUNDRUM-3 and DUNDRUM-4 for indigenous peoples, who are internationally over-represented in forensic mental health services. Suggested changes would require a negotiated, collaborative process between Māori cultural expertise and the original authors of the measures.