What does mental illness mean for Māori?
A review of literature that challenges the appropriateness of the Western approach to diagnosis and treatment of mental health disorders as applied to Māori in New Zealand. The author raises the need to include cultural considerations and variables in mental health service delivery. The topic of “Māori women during pregnancy and childbirth and their mental health and care” is cited as being of particular research interest focussing on these discussions.
The issues raised in this paper challenge the value of a strictly medical approach for the provision of mental health services to Māori. The importance and application of cultural contributions and cultural variables to these processes for Māori currently remains as an area of development.
Reference: Social Work Review. 2006;18(2):36-42.
The contributions of culture and ethnicity to New Zealand mental health research findings
This review of studies conducted in specialist psychiatric and primary care populations in New Zealand allowed comparisons between Māori and non-Māori in terms of clinical phenomena, therapeutic care and cost of care. While there were variations in the methodologies used and subsequent results this paper reported obvious differences in therapeutic experiences, cost of care and diagnostic patterns between Māori and non- Māori. The authors proposed that the variations emphasise differences between these ethnic groups, which account for the differences in experiences of the users. The authors also advocated that the variations may reflect inadequacies in service provision for Māori and that an examination of the validity of Western approaches in relation to appropriateness for Māori is warranted.
This article follows the previous paper in terms of promoting the notion of cultural appropriateness of mental health service delivery. Furthermore, research in the validity of Western approaches in the context of Māori mental health service improvement will go some way to address the concerns expressed.
Reference: Int J Soc Psychiatry. 2007;53(4):317-24.
Taking account of culture: the contracting experience of Māori mental health providers
This qualitative study investigates the operation of Māori mental health providers in a New Zealand health context dominated by “Western approaches to accountability, contracting, and performance measurement”. Findings suggest that Māori mental health providers “regularly and routinely work outside the scope of their contracts to deliver mental health services to Māori”. The extra-contractual activities were attributed to the importance of “those values and norms enshrined in Māori culture” that benefit Māori mental health users. To conclude, the paper proposes a mental health sector contracting framework that is adapted to account for the inclusion of cultural values and processes.
Importantly, this paper offers a framework that acknowledges and supports the value of cultural practices and processes previously viewed as “extra-contractual activities”, which has significance in the current Whānau Ora contractual environment.
Reference: Alternative: An International Journal of Indigenous Scholarship. 2007;3(1):124-41.
Crisis engagement in mental health: a New Zealand Māori contribution
Fundamentally a review of national and international literature on the delivery of mental health crisis services. Crisis presentations are viewed as those who might pose a threat to the community or themselves, of which most receive coercive placement and treatment. The authors of this article advocate for crisis service provision in New Zealand that promotes “therapeutic alliances” between the clinician and tangata whaiora (consumer) and one that should be more interested in “how we deliver” not “what we deliver”. The authors believe crisis service provision for Māori could be improved by the inclusion of indigenous processes and knowledge as well as provision of an atmosphere where relationships and respect are enhanced.
A recurring theme on the importance of developing culturally relevant health services for Māori. The authors provide various examples viewed helpful to assist those who deal with tangata whaiora (consumers) in crises. These approaches focus on de-escalating situations and are premised on building relationships, providing solutions and mutual respect.
Reference: Int J Ment Health Nurs. 2008;17(5):317-25.
Tangata whaiora/consumers perspectives on current psychiatric classification systems
This qualitative study investigated the views of tangata whaiora regarding the usefulness of mental health classification systems in New Zealand. Respondents advocated that the utility of any classification system or diagnostic tool depended on the quality of the process and “how the tool assisted the tangata whaiora to make sense of their distress in order to live meaningful lives”.
Tangata whaiora are a major stakeholder in mental health service provision. This is an excellent example of research that includes the important perspective of tangata whaiora to guide service provision improvement.
Reference: Int J Ment Health Syst. 2008;2:7.
Ko wai ahau? (Who am I?) How cultural identity issues are experienced by Māori psychiatrists and registrars working with children and adolescents
This qualitative study was conducted with a combination of both Māori psychiatrists and psychiatric registrars practising in New Zealand. The author proposes the essential inclusion of cultural variables in training for psychiatrists with particular emphasis on cultural identity. Psychiatrists would then be better placed to provide cultural appropriate responses for Māori who present with these issues.
Totally agree with the author that the findings have implications for appropriate curriculum development for psychiatrist training in New Zealand.
Reference: Australas Psychiatry. 2008;16(3):200-3.
Rehabilitation and indigenous peoples: the Māori experience
An account of the urgent action needed to address the health inequities for the indigenous people in New Zealand. The author proposes a framework based on an indigenous holistic approach to care, provided by a multidisciplinary team that supports both clients and their whanau who access rehabilitation and disability services.
In the current Whānau Ora focussed environment that promotes Māori appropriate service provision and improvement there is a real opportunity to address the significant issues raised in this paper.
Reference: Disabil Rehabil. 2010;32(12):972-7.
Whakaora nga moemoea o nga tūpuna – Living the dreams of the ancestors. Future planning in a Kaupapa Māori CAMHS team
The authors support the inclusion of Māori beliefs and values through whakatauakī (proverbs) to inform service planning and development in mental health services for Māori. The whakatauakī: Whakaora ngā moemoea o ngā tūpuna – Living the dreams of the ancestors was chosen by a Kaupapa Māori CAMHS team as the foundation for their strategic discussions. Staff members were encouraged by a facilitator skilled in tikanga Māori (customs, beliefs and values) to articulate their thoughts not only as recipients of knowledge from an “ancestor” but also as an “ancestor” of future generations. This process valued learning from the past, the present combined to provide a vision for the future.
Fundamental to an approach that utilises Māori beliefs and values in service planning, development and provision is the access to personnel skilled in tikanga Māori. There has been a longstanding desire to have a workforce operating in mental health services for Māori with such a skill base.
Reference: Australas Psychiatry. 2009;17(1):S104-7.
The Wharerata Declaration— the development of indigenous leaders in mental health
This paper describes an international indigenous people’s agreement to promote mental health sector leadership. The protection and support of health and mental health for indigenous people is articulated as one of the goals of indigenous leadership. This is informed by indigenous knowledge and indigenous networks tribally, community, across sectors, regionally and internationally as well as partnerships committed to the development of indigenous leadership.
Absolutely agree with the authors that there is a growing body of knowledge promoting indigenous perspectives on health and mental health and are worthy of inclusion because they add value to the provision and delivery of these services to indigenous people.
Reference: The International Journal of Leadership in Public Services. 2010;6(1):53-63.
