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- Introduction
- Establishing Kaupapa Maori Mental Health Services Within the HHS
- Effective Mechanisms for Providing Specialist Kaupapa Maori Services
- The Setting for Specialist Kaupapa Maori Services
- Conclusion
- Footnote
Introduction
The evolution of a people is assisted by structures that lend themselves to participation beyond the process of conversation and consultation.
The approaches being used to develop mental health services for Maori can provide a platform for success, not only for Maori but for all New Zealanders. Should the basis for movement forward be one that is inclusive rather than exclusive, then the ability to develop creates a pathway that is proactive and responsive to the needs, desires and aspirations of Maori. Bringing together various approaches will assist in the establishment and sustainability of health services for Maori. This allows enormous diversity of approach. It is within such diverse paradigms of approach that progress and development are made.
In relating the experiences in the role of Kaiwhakahaere (Manager) assisting in establishing and developing Maori Mental Health Services, I would like to acknowledge that mine is but a small part of the overall contribution. Many people have made considerable efforts towards achieving an effective configuration of services within the mental health arena that is specific to Maori. This is a purely systemic view of the processes. Relationships that exist and expand with other individuals, groups and organisations are central to sustainable growth and development.
Establishing Kaupapa Maori Mental Health Services Within the HHS
My experience of assisting with establishing specific kaupapa Maori mental health services has been within the Health and Hospitals Services (HHS). It is important, therefore, to provide some contextual background; Both historically and currently, the structures can reflect a strong bias to a patriarchal and Western medical model. This influence has at times been a barrier to, rather than assisted in, access to and the development of effective mental health services for Maori. Maori would say that at times the struggle has been isolating, with punitive consequences. It is important to note that policy, legislation and the various systemic processes that are a part of HHS can contribute to a framework that is still, at times, dictatorial and inflexible to new and innovative thinking. The monocultural paternalistic approach that has often been adopted within the HHS environment does not take account of or even recognise an indigenous framework. However, with a clearer acknowledgement from government and the public sector and in view of the intent of the health reforms, it became important that health services specific to Maori mental health were purchased as a discrete area. With this acknowledgment came great celebration and enormous optimism and hope – finally the ability to ring fence resources had arrived. Defined resources could now be utilised solely in ways that would contribute to improving health outcomes for Maori.
There is no definitive list or recipe for the establishment and progressive development of better Maori mental health. Such developments are not part of a static process and must be approached with a vision. This vision must be inclusive, caring and incorporate Maori belief systems rather than be based solely on western ideology. There are, however, a number of components that need to be planned for and resourced in order to develop an effective Maori mental health service.
Effective Mechanisms for Providing Specialist Kaupapa Maori Services
Examples of effective mechanisms for providing specialist kaupapa Maori services include:
- Kuia (elder Maori women) and koroua (elder Maori men) influencing, guiding and advising in all aspects of the service, both delivery and development
- Development of identity for both kaimahi (staff) and tangata whaiora (clients) encompassing Te Reo (Maori language), tikanga (values and beliefs) and Maori models of practice
- Recruitment and retention of skilled Maori staff
- Workforce development opportunities for Maori
- Provision of training/education/information about kaupapa Maori approaches to external organisations within the mental health sector and other organisations that impinge on good delivery of services
- Ability for kaimahi, tangata whaiora and whanau to participate at all levels of mental health service and Maori mental health service development
- Research that supports further development for Maori
- Clear accountability internally and externally including all the layers of service delivery and interactions within that, for example, Iwi (tribe)
- Advocacy
- Networking by all kaimahi internally and intersectorally including Government and Non government organisations groups
- A physical environment that is conducive to Maori beliefs (ie, marae based) ·Autonomy and control in development of Maori mental health services (ie, budget-holding)
- Striving to work with whanau, thus contributing to overall Maori development ·Access to information that assists informed development, both internal and external ·Building and maintaining relationships at all levels with Tangata Whaiora (consumer) and whanau groups, individuals, etc. on a national, local and international level.
These aspects help to effect change that is positive for Maori people. Many qualities present in this area reflect Maori processes. It is important, therefore, to acknowledge this and ensure that infrastructures in mental health service delivery incorporate Maori processes, both at a managerial level and within service provision.
The Setting for Specialist Kaupapa Maori Services
The contemporary setting in which Maori apply their own belief systems constantly provides challenges to the actual enactment of this goal in every aspect of interaction. For example the crucial influence and direction of kuia and koroua is often underestimated in its importance within Western settings. The involvement of our kuia and koroua is vital to effective service delivery and development. The korowai (cloak of protection) that they provide to each interaction that takes place at all levels of service provision and development is pivotal.
However, we must ensure that the reciprocity within the relationship of our Kaumatua remains protected within Western processes. Without our kaumatua (elders), there would be little progress in this area, and certainly the ability to translate concepts and understandings into an evolutionary process would be lost. The recognition of each role and the contribution to the overall picture being achieved is crucial; the defining of roles and expectations is not dissimilar to that of being on a marae (ancestral house). Within a Maori context such as a Marae each person maintains a role; no role is considered to be insignificant but each role is appreciated for its contribution to the whole.
The key characteristics fundamental to achievement drive progress at all levels of organisations – strategically, operationally and within policy making. Therefore, these must be applied not only at a HHS level but also within the interrelationships between the Health Funding Authority (HFA), the Ministry of Health (MoH) and the Government. The HFA has the ability to work collaboratively with Maori health service providers at each part of the continuum of health services in New Zealand – primary, preventive, secondary and tertiary. This would assist to inform the way in which frameworks are operationally implemented. Currently, although there has been much effort towards this, there is still a punitive process that occurs that strikes at the heart of collective responsibility. The nature of competitiveness can be a bar to developing and sustaining Maori mental health services. We as Maori must influence processes utilised by crown organisations with the Maori ideology of the greater good, not be immobilised by the individualistic Western approach which encroaches on our cultural norms.
It is difficult to establish services that are truly integrated within the secondary health sector. The move to specialisation within the purchasing of mental health services has hindered Maori growth and lead to fragmentation. It is only the ability to influence the setting of the provider that currently allows some redefinition of provision of these services. This, at times, can lead to resentment from within other areas of the mental health services where it may be perceived that precious resources from within an already stretched sector are being redirected. Misunderstandings can lead to greater friction between Maori and non-Maori, giving rise to adversarial situations that impinge on and sabotage development. The goodwill that I have personally been privileged to experience is not always present.
Over time, we as Maori have been clear in identifying where there is an ability to enhance and strengthen the manner in which services are purchased. It is obvious that there is a move within the health services towards developing a purchasing framework fundamentally built on the basis of Maori values, beliefs and principles which would account for the evolutionary processes we have undergone as a people.
It is important to evaluate and research those things that are contributing to better outcomes for Maori as a people. However, as with the provision of services and the development of an appropriate purchasing framework, Maori must utilise Maori paradigms for this continued research and development.
Conclusion
Maori must draw their ‘line in the sand’, clearly identifying the point of the health service continuum that has been re-evolved with positive influence in the mental health services. This allows measurement of that which has been successful, aligning the social and political determinants of whanau, hapu, iwi, communities and societies. The direction from government has provided some leverage for development, but this does not necessarily translate directly to what is happening in the operational reality. Greater control of resources and their use will create opportunity for continued evolution and is paramount in sustainable development.
The continuation of development is interrelated to Maori political infrastructure. The political infrastructure is particularly important for it directly impacts on our ability as Maori to participate in health services development overall and therefore in health. No component of Maori development should be viewed in isolation. It is with a truly integrated approach to the development of services for a diverse population that we are able to identify the key tenets that cross the sectorial and ideological barriers. To contribute effectively to the overall development of an indigenous people in partnership with others (in the case of New Zealand, with the Crown), sustainable development must be viewed as achievable and as essential.
We as Maori cannot reach our full potential without challenging ourselves as we take forward into the next millennium a stronger ability to self-determine, therefore, mapping our path and co-ordinating our approach to interactions with the Crown and others both nationally and internationally.
The complexities of diversity provide opportunity. It is important that we remain focussed on the future while learning and developing from our past.
He aha te mea nui ki te Ao
He Tangata he Tangata he Tangata
What is the most important thing of all,
it is People, it is People, it is People
Footnote
- The author has written this paper in a personal capacity. It does not necessarily represent the current or proposed viewpoint of Capital Coast Health.
