Craccumspeaks to Dr. Diana Kopua – director of Te Whare Wananga o Te Kurahuna and practitioner of Mahi a Atua: an indigenous approach to mental health that incorporates mātauranga Māori and Te Ao Māori.
Can you explain how Māori approaches to treating mental health issues differ from Western approaches? What is Mahi a Atua?
Māori approaches draw from a system of knowledge that is referred to as mātauranga Māori. It is a completely separate system of knowledge from western knowledge. Western approaches to human suffering have dominated our global understanding of how to understand and control human suffering. Mental health services therefore have been shaped and funded based on western approaches that prioritise western ideologies such as individualism. Mahi a Atua promotes the need to value indigenous ways of knowing whilst ensuring we remain critical thinkers and responsive to feedback. Mahi a Atua calls for epistemic justice.
Mahi A Atua can be viewed in three ways:
Mahi a Atua as a philosophy: Mahi a Atua has been referred to as a ‘worldview’, a Māori paradigm, an ontological transformation. As a collective, those who engage in collective conversations using Mahi a Atua principles, are reclaiming their right to indigenising a unique way of ‘studying’ wisdom. Our Māori creation and custom stories are the foundation from which we question, discuss and debate ideas about existence, knowledge, values, mind and language. We promote the inherent rights of indigenous peoples to indigenise all the spaces we occupy.
Mahi a Atua as an indigenous strategic framework: Considered by some to be a transformative model of care, Mahi a Atua is deliberately grounded in indigenous knowledge, active learning and feedback. A Mahi a Atua worldview inspires success in achieving systemic change within services.
Mahi a Atua as an intervention: This approach involves facilitating hui with Māori whānau and sharing traditional narratives, Māori creation stories (pūrākau), to connect with and liberate our people. It is ancestral healing, drawing from the creation and custom stories of Māori atua (gods), to better understand how our ancestors made sense of their realities.
How have Māori traditional healing practices been affected in the ongoing process of colonisation?
Colonisation was justified by the idea that Māori were primitive and less rational than their European conquerors. Colonisation was not about a dialogue between cultures but rather involved a monological imposition of one way of seeing and speaking about the world, and the elimination of our Māori traditional healing practices was the expected consequence. Legislation such as the Tohunga Suppression Act 1907 would contribute to the demise of tohunga skilled in both the arts and healing practices. Māori who have reinstated traditional practices are often confronted by beliefs that the western knowledge system is the default system for all. Many efforts to promote Māori healing practices are considered secondary to the ‘mainstream’.
In what ways do Western approaches to mental health treatment play a role in colonisation?
Psychiatry’s history, assumptions and practices have impacted many people across the globe and in particular indigenous peoples. Simply put, colonisation involved Europeans believing that their way of understanding distress and how to manage it was superior to indigenous peoples ways of knowing. This continues today and although we understand that evidence based practices are important, many of the practices used in mental health services are based on assumptions and misinformation that is not generalisable, reliable or proven to work for Māori in general. Regardless of the dismal statistics for Maori, many mental health services continue to believe the issue is a resourcing issue as opposed to an idealogical issue.
Is our current mental health system responsive to Māori? Are practices like Mahi a Atua integrated into the health system and what are the obstacles in providing this care?
No, the mental health system is not responsive to Māori.
Regardless of a formal evaluation showing true progress when Mahi a Atua was embedded in a heavily Māori populated mainstream service, it has not been supported by the Ministry of Health to scale across the country. Instead, an overseas models has been adapted and funded across Aotearoa to implement significant change. I would say that this is a prime example of institutional racism. The final say about the control of the design of mental health services is in the hands of those who refuse to give Maori funding authority.
As a psychiatrist and the director of a small indigenous whare wananga, our focus is on training individuals and teams to become Mataora; specialists in Mahi a Atua. We also transform services that are serious about addressing Māori inequity. We have integrated Mahi a Atua into a number of services now and the outcomes are positive.
How has the mental health of Māori been affected in the months since COVID hit the shores of Aotearoa?
I do not have the most up to date information about how COVID impacted Māori across the country. The following are my perspectives based on what I understand.
Firstly however, Māori inequity prior to COVID was a serious issue that had been largely ignored within mental health services. The crisis in mental health was already known before COVID. There was a lack of capacity, poor staff morale with significant recruitment and retention issues, and patient outcomes particularly for Māori were concerning. There was an international call from the United Nations for mental health reform. The Mental Health and Addictions report in 2018 also highlighted the need for change but lacked severe criticism of systemic racism and in fact the Māori report that accompanied the review was withheld. Inside that Māori report (Whakamanawa) was significant support for a Mahi a Atua system – Te Kuwatawata, but it was ignored. It is hard to talk about the COVID crisis when there was already a huge crisis.
What Te Roopu Whakakaupapa Urutaa informed us of is that if COVID was to reach Māori communities then that would worsen the Māori inequity in health overall.
The Ministry of Health and the work to address mental health inequity for Māori was put on hold during COVID and therefore putea for the expansion of Kaupapa Māori mental health services, a new primary mental health services, and other contracts, were delayed. This meant that organisations needed to delay any systemic change required.
Despite this, Te Korowai Hauora o Hauraki acknowledged that there was already a significant crisis that needed addressing – racism. They committed to transforming their organisation without any ministry funding and COVID offered an opportunity to do things differently immediately. Leaders in the organisation were already meeting twice a day for regular COVID updates and so this forged the space for transformation. They agreed to invest in the Mahi a Atua model and a second Te Kuwatawata service was established on the 1st April 2020, in the midst of lockdown.
Meanwhile in other ‘usual care’ services some mental health professionals were unable to see whānau in person during COVID and were worried about the lack of ability to properly engage with whānau via virtual appointments.
At one particular primary mental health service there was a significant increase of referrals for assessment and treatment but the number of Māori referred were low, which is not in line with what statistics tell us about Māori and mental health. I believe that even though organisations believed they did not have enough resources, that increasing resources would not address the real issue – which is how to develop systems that Māori want to use when in distress.
One of the hypotheses I have is that when COVID lockdown forced whānau to stay home, there was less racism experienced at the systems interface. Whānau were able to spend time with loved ones and many of those with significant social needs were responded to by organisations who were quick to adapt and mobilise their resources accordingly. Many Māori were already struggling with low household incomes so spending time with whānau without societal pressures was for many a breath of fresh air. The Mental Health and Work report that was released in Dec 2018 highlighted the impact of substandard employee mental health policies. This being the case, several Maori were likely enjoying time away from a stressful environment. Of the many recommendations from the report, which was very supportive of indigenous frameworks to improve mental wellbeing of employees, one of the recommendations was to explore the expansion of both whānau ora workers and Mataora – Mahi a Atua specialists.
The other noticeable observation for me during COVID was the promoting of western approaches for the public in distress. But that didn’t stop Māori who had access to facebook in tuning in by the hundreds to Facebook wananga forums where many of us who are promoting mātauranga Māori were offering frequent live feeds. These involved spiritualists, Māori meditation, Maramataka Māori, political forums, waiata, karakia, Mahi a Atua and many many more. Māori community members were also taking active roles in their community by setting up roadblocks to prevent COVID entering their ‘vulnerable’ communities. Others were getting stuck in to providing kai to their communities. There was a community vibe happening in many pockets of Aotearoa.
When we look at mental health we need to look at the whole community and not just whether one individual has symptoms consistent with what are referred to as psychiatric disorders. COVID was to many Māori, an opportunity for our earth to breathe again. While I do understand that this was not the experience for everyone the point I am trying to make is that regardless of the racism Māori are continuing to fight for the right for epistemic justice!
How might Mahi a Atua be used to treat these issues?
The real issue is systemic racism. That is what needs our attention. The education system is failing Māori but is slow to shift its behaviour and attitudes. If we cannot inspire our Māori children in their learning then we will end up with more clogged up mental health systems, who are also struggling with the issue of racism. Mahi a Atua takes this issue extremely seriously while having fun and getting creative as a collective. We deliberately reinstate our stories as allegories to shift the collective mindset of Aotearoa. It is this shift that we believe is needed so that those in privileged positions learn to unlearn their privilege.
What can we do to support further equity and funding for Māori within our health system?
In general, we all have a responsibility to understand Aotearoa history and to become an anti-racist society.
The real issue and maybe the question that needs to be asked is, how do we change the attitudes and behaviours that continue to perpetuate racism? We need bold leaders who can challenge the status quo and prioritise the need to address the inequity for Māori. But we also need the average New Zealander to also speak up and say no to racism.
Whilst the Ministry of Health is wanting to fund Māori services, we must not accept a colonised model with a Maori name. There is a lack of openness to establish alongside the services, an indigenous workforce development and training arm. We must acknowledge that indigenous knowledge is as important, and we believe in many cases, more important in working toward a balanced society.