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.