CHAPTER FOUR: ANALYSIS, RESULTS AND DISCUSSION
4.5 Theme Four: How Professionals Perceive Young Peoples Experience in the Mental Health System
4.6.4 The Benefits of Kaupapa Māori Informed Practices and Models
Another relational model that participants presented as a beneficial alternative to the current system, was an increase in Kaupapa Māori informed models and practices.
As outlined in theme one, there are relatively few Kaupapa Māori informed mental health services and this should be remedied in accordance with The Treaty of Waitangi/Te Tiriti o Waitangi (Beutow & Coster, 2001; Te Ara, 2016), The New Zealand Public Health and Disability Act 2000 (New Zealand Legislation, 2022), and
112
the United Nations Declaration on the Rights of Indigenous Peoples (United
Nations, 2007). However, an increase in Kaupapa Māori approaches also aligns with the collective and relational practices that participants presented as a suggested improvement strategy for the system moving forward.
According to Waitoki (2016) Mātauranga Māori is a “unique way of viewing the relational phenomena of the world, taking into account Māori methods of
comprehending, observing, experiencing, studying and understanding everything”
(pp. 284). Durie (2012) encourages the realisation that Mātauranga Māori is not an ancient form of knowledge that is static, and in the past. Instead, it is a knowledge that is always changing and evolving, designed to guide people. Mātauranga Māori, as a framework of knowledge, can be applied to all traditional and contemporary aspects of society, including education, science, technology (Waitoki, 2016), and arguably the mental health system. A Mātauranga Māori approach to the mental health system is not a new idea or implementation, several Māori informed health models based in holistic understandings such as Te Whare Tapa Wha (Durie, 1985) or Te Wheke (Pere, 1997) are implemented across the health sector presently, informing professional training and development (Levy & Waitoki, 2016). These models of health, comparative to the standardised biomedical model, intrinsically rely on holistic understandings, incorporating physical health (Taha Tinana), mental health (Taha Hinengaro), spiritual health (Taha Wairua), the immediate and extended Whānau and other relational aspects (Taha Whānau /Hononga), an individual’s connection to their ancestral land (Whenua) and their pride, cultural identity, attitude, and self-potential (Mana Motuhake) (Levy & Waitoki, 2016; Macfarlane, 2016; Mental Health Foundation, 2023). However, as outlined by the participants in theme one, these models are often only discussed within training and then
inadequately implemented into practice.
The study of these models in relation to decolonisation and Māori experiences within the mental health system is valuable work that is already being researched,
113
arguably by Māori for Māori. As a Pākehā woman, especially without the regular guidance of a cultural supervisor, it is vital that I unequivocally state that the intention of this research project is not to replicate or provide additional research within this field. Instead, the purpose of this section is to draw on participants who stated that while Kaupapa Māori informed models, such as Te Whare Tapa Wha (Durie, 1985) or Te Wheke (Pere, 1997) are discussed as an “ideal”, they are not adequately implemented in a genuine way. These models, draw on ideologies that vary significantly from the standardised biomedical model which may ignore elements of wellbeing due to its reliance on the diagnostic approach.
Participant #35 outlined the importance of incorporating a holistic wrap around approach, such as the Kaupapa Māori informed model stating, “you've got to take a holistic approach [...] you can't just look at one aspect, especially with youth. [...] Because it's always inter- linked”. Other participants echoed this statement referring the holistic, Kaupapa Māori informed models as an “obvious” approach (#11), allowing for “care continuity and significant relationship building” (#53), both elements missing within the current system. Participant #53 stated that a mental health system that truly
incorporated “Kaupapa Māori would be the opposite of the chop, change, take you here there and everywhere. That's the antithesis of Te Ao Māori”, highlighting the lack of
collaborative care in the current system and how this might be mitigated with the introduction of Kaupapa Māori informed practices. Participant #53 then stated that a system truly incorporating Te Ao Māori would “utilise the community to surround that person, rather than take the person to a whole lot of different places”. Participant #53
elaborated, stating that this approach mirrored many of the principles discussed earlier in the interview in relation to collaborative, holistic care. The comments made by these participants, and supporting literature, suggest that a system based on Kaupapa Māori informed practices, would be intrinsically collaborative, would cater to all elements of wellbeing holistically (Levy & Waitoki, 2016; Macfarlane, 2016;
Mental Health Foundation, 2023), and would utilise the community to provide care
114
(Whānau Ora, 2023), rather than expecting a young person to travel to various clinical settings. This paints a picture that contradicts the individualistic nature of the current system. A system that prioritises standardised treatment often focussing on one element of wellbeing such as diagnosis and encouraging the ‘chop and change’ between services and locations.
A model that incorporates the Kaupapa Māori informed practices outlined above, is the Whānau Ora framework, as defined and explained in the literature review. This approach benefits Māori due to its ability to closely reflect the nature of the treaty partnership (Taskforce on Whānau-centred Interventions, 2010); its ability to consider and elevate the Māori culture, focussing on continuous, holistic, Whānau oriented cultural practices, avoiding the “patch and dispatch” quick fix, quick discharge culture (Moyle, 2014); and it considers the symbiotic relationship between Whānau and the individual, creating strategies that maximise positive outcomes for the Whānau as a whole (McLachlan et al., 2014). However, this approach also
positively impacts non-Māori (Taskforce on Whānau-centred Interventions, 2010).
Drawing on the importance of caring relationships through the feminist ethics of care and the analysis of collaborative care and holism, we can see that relational approaches have benefits for individuals, irrelevant of culture or ethnicity. This wrap around, holistic approach outlined through the Whānau Ora framework or Māori informed health models such as Te Whare Tapa Wha (Durie, 1985) or Te Wheke (Pere, 1997), incorporates and celebrates the importance of relationships and collaboration. As outlined by Participant #53 earlier in this section of the chapter, ideologies and practices outlined within Mātauranga Māori approaches to mental health, reflect many of the ideologies and practices discussed in non-Māori literature on collaborative care and therapeutic relationships. Therefore, the genuine and widespread incorporation of these practices within the mental health system, would have a twofold impact. The incorporation of these practices would benefit Māori and therefore upholds The Treaty of Waitangi/Te Tiriti o Waitangi and may address the
115
concerning statistics of youth Māori mental health concerns across the country (Ministry of Health, 2022). Whilst also benefiting other cultures across New Zealand through the incorporation of more collective, relational approaches, as an alternative to the individualistic nature of the neoliberal model of operation.
A Kaupapa Māori approach to mental health, such as the Whānau Ora framework, aims to provide quality rather than quantity, focussing on the results of the
intervention, rather than simply recording the inputs and outputs (Taskforce on Whānau-centred Interventions, 2010). This is a direct contrast to the quick fix culture discussed in theme one. It also values collectivism, Whānau, and being
interdependent with one another, rather than self-sufficient as encouraged by the neoliberal model of operation (Podsiadlowski & Fox, 2011; Poirier et al., 2022). It also views the individual as a whole, focusing on holistic, mana enhancing therapeutic practices (Levy & Waitoki, 2016), rather than a deficit focussed diagnostic model (Boggs, 2014; Martin et al., 2000; Nelson, 2019; Thachuk, 2011). Overall, we can claim that the Whānau Ora approach, and the Kaupapa Māori informed health models outlined above, draw on relational approaches, contrast to neoliberalism and
individualism. While the literature and participants have highlighted the benefits of this model, both for Māori and non-Māori, we can see a lack of widespread
implementation across the mental health sector, arguably due to the contradictions between individualistic and collective approaches.
4.6.5 Other Alternative Approaches to Mental Health: Sociological