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Tariana Turia Speaks To Aus/NZ Psychiatrists

Hon Tariana Turia

Speech To Royal Australia And New Zealand College Of Psychiatrists, Rotorua

Tena tatou e hui mai nei ki te whakatau i nga kaupapa o te ra nei. Tena tatou katoa.

Thank you for inviting me to participate in this panel discussion - 'From the Outside Looking in'. I would also like to acknowledge my fellow panelists this afternoon. All of you have significant experience in your respective areas, with the issues surrounding the mental health, your experiences 'From the Outside Looking in'.

Although I stand here today in my role as the Associate Minister of Health and Maori Affairs, with responsibilities for the areas of Maori health and social development respectively, I also stand as an uri (descendant) of Ngati Apa, Nga Rauru, Whanganui and Tuwharetoa. It is from my whanau, hapu and iwi that I draw my identity and my beliefs, they provide the foundations of who I am. It is those foundations that guide my commitment, strength and inspiration as a Government MP with ministerial responsibilities.

Mental health is a very important issue for whanau, hapu and iwi, one that most whanau will be very familiar with. Today, I want to focus on the place of psychiatry and thereby psychiatrists, within whanau, hapü and iwi development.

It is disturbing that Maori are negatively over-represented in the majority of institutions where psychiatrists are employed and often are not admitted for psychiatric assessment until they reach a critical stage.

During recent times, Maori have not been well served by the mental health services in New Zealand. This has not surprised me given the low number of Maori psychiatrists, the strong emphasis on the individual within psychiatry and the genealogy or history of psychiatry in relationship to indigenous and minority peoples.

The genealogy of psychiatry had its genesis in Western scientific thought. Psychiatry formed one part of this wider project, characterised by the all-encompassing domination of scientific objectivity. The idea of the ‘individualistic individual’ that was promulgated by these practices served to further the domination of certain groups within society and marginalised others. Indigenous peoples became relegated to the margins. In an indigenous worldview, the idea of forming an identity for oneself that is not embedded within family and community structures are anomalous, is not part of our psyche. The individualistic individual does not gel with an identity embedded within family and community structures, our lands, rivers, mountains, lakes and seas.

In the region where I come from, our river is the source of our being. We have a saying:
E rere kau mai te awa nui
Mai te kahui maunga ki Tangaroa
Ko au te awa, ko te awa ko au

(The river flows from the mountain to the sea,
I am the river, the river is me)

The historical practices of psychiatry have resulted in it claiming for itself the status of the norm - the ‘right’ way to measure, to observe, to analyse, to assess, to intervene and to evaluate. This popular and professional authority given to scientific activity has, in turn, conferred respectability upon the tools that reflect these values.

Deviations from the norm can then be easily identified and treated accordingly. So while this enables us to recognise the differences between one individual and another, it does not enable us to view these differences through the eyes of the other.

We might recognise the possibilities for different views of reality, but it isn’t possible to see anyone else’s with the same assurance of knowledge that we bring to our own. In recognition of this, we must therefore question the notion of any uniform criteria for ability or intelligence within a pluralist society.

The ability for the psychiatry profession to respond in an appropriate and effective manner to a diversity of cultures and worldviews is required. For us in Aotearoa, this involves recognition and understanding of the diversity of world-views within whanau, hapü and iwi. Not all whanau, hapü and iwi have had the same experiences when it comes to the key influences that may have shaped their view on life and their conception of identity.

A person's culture has a significant part to play in the way they interact with mental health services and react to treatment. At present, non-Maori culture shapes the diagnosis, labelling and treatment of mental health.

Culture has a significant part to play, not only in the delivery of mental health services to Maori and their restoration to mental health and wellbeing, but also to the assessment, diagnosis and treatment particularly of Maori.

Wairua, for example, is about good spiritual health and contributes to good mental health and well-being. Wairua influences all other aspects of life including the mental, emotional and physical states.

Tangata whaiora need to believe in themselves to develop total well-being. Total wellbeing relies on the individual being able to balance wairua, cultural values, family and history, emotional and physical states. If you take away the wairua, you take away the essence of being Maori. It plays such an important role in our holistic wellbeing and cannot be ignored.

As noted by Mason Durie, Head of Maori Studies at Massey University, enthusiasm for the promotion of a Maori cultural identity should not get out of step with clients and their whanau.

‘Having been alienated from a culture and whanau during earlier policies of institutionalisation, and through the medium of imposed colonial laws, it would be ironic indeed if the situation were compounded by alienation through tikanga Maori – Maori lore.’

The low numbers of Maori psychiatrists has serious implications in terms of the ability of the psychiatry profession to provide appropriate psychiatric services for Maori. If Maori are to receive appropriate psychiatric services it is imperative that there are more Maori psychiatrists, as well as non-Maori psychiatrists who are able to practice in a culturally safe manner. Increasing the numbers of Maori participating in the profession is only part of the solution.

The profession must also increase its participation and access into the contemporary Maori world. An awareness or knowledge of cultural identity cannot be merely ‘tacked on’ to the profession. It is not enough to cover over our real responsibilities merely with a bicultural frill.

I am sure that this is not the first time that you will have heard constructive criticism levelled against the psychiatry profession. I am of the view that there exists an ever-growing awareness of the limitations of the scientific tools and Euro-centric values evident in much of Western scientific thought.

An awareness that not only are these tools not effective, but that they are harmful as well – in the way that they set about to undermine a sense of identity defined in cultural terms. As they say, recognising the problem is halfway to solving it. Of course it is the other half of the solution that is the hardest. And I want to make a contribution to solutions by offering these thoughts forward.

It is vital that we all aim and strive to increase general awareness of the importance of whanau, hapü, iwi when dealing with Maori by the mental health profession of Aotearoa.

There needs to be effort made to develop and support medical school courses where an awareness of Maori needs has become more than just an add-on. Such courses reflect a focus on cultural understanding and an emphasis on recognition of the importance of cultural issues affecting concepts of Maori health.

We know that the Maori view is based on a holistic perception of development that is firmly embedded within the community and family structures. The growing commitment to a holistic approach to wellbeing must be fostered. This will be a significant step towards aligning the scientific concepts with tikanga-a-iwi.

It could be acknowledgment that whanau and hapu are best placed to recognise their needs and preferences as a community and have the ability and knowledge to create their own solutions too. Mainstream thinking based on centralised planning models have been tried and failed.

Effective involvement by iwi, the tangata whenua, in the planning, development and delivery of mental health services to meet the needs of Maori, our aims and aspirations, is necessary.

We can pull out three main themes that currently present barriers to positive outcomes for Maori – Euro-centric world-views; legal and institutional barriers; and resource deficiencies.

The Government has a role to play here.

- In providing resources that can facilitate the strengthening of the important resource of the Maori community.
- In ensuring that any legal or institutional barriers that Maori have faced in the past are removed.

- In fulfilling its obligations as a Treaty partner through the support for the self-determination of whanau, hapü and iwi.

The Mental Health Commission has recently put together a publication recording the körero of Maori as they share their experiences of mental illness. I would like to share with you a little of Tania’s story, as I think it illustrates very well the ideas I have been raising here today. Tania shares with us her experience of dealing with the psychiatry profession in particular. I feel that the issues she brings to light are relevant for us to consider here today.

"The way my experience was viewed by my whanau was very, very different from the way it was viewed by the psychiatrists and the nurses. What people call mental illness is what we call wairangi or poorangi, which means to exist in another worldly way. A psychiatrist from Switzerland will believe I’m hearing voices and have schizophrenic tendencies, but to a Maori I’m hearing my tupuna talk to me. The whanau better understood what was happening for me than I knew myself, and they guided me through a process of kaupapa Maori healing. Mostly, reconnecting me with my whenua, my moana, my maunga and my marae, and guiding me through tikanga and matters of wairuatanga. Because it was lost to me. All my life I had been raised in the Pakeha way and only had token involvement as a Maori. I was totally out of balance in terms of who I am, and by returning to my whanau I learnt what it is to be Maori."

In 1998 the Mental Health Commission organised hui throughout the country for Maori who were involved with kaupapa Maori and mainstream mental health services. This brought home the need to measure the outcomes of kaupapa Maori treatment in terms of assessment models developed by Maori themselves. Hui participants strongly recommended that the Whare Tapa Wha model, a holistic approach to wellbeing encompassing taha wairua, taha hinengaro, taha tinana and taha whanau, must be used to measure outcomes for Maori who have chosen to have kaupapa Maori treatment. This approach is all about knowing who you are, where you come from, and re-integrating yourself with your people in your own way, as the basis of recovery.

There is a need for comprehensive and responsive consultation with Maori. They are consistently over-represented as the recipients of psychyiatric services and this demands nothing less than a holistic response that aggressively seeks out and demands to know the reasons why and how we can all play a part in the solution to these problems.

Thank you once again for the opportunity to address this conference today. There is a lot of work to be done but I feel confident that we, all of us here today have the will to do it.

Na reira, tena koutou, tena koutou, tena koutou katoa.

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