History and Current Perspectives of Mental Health in Aotearoa New Zealand
Legislation in the field of mental health is an integral condition for the protection of the rights of citizens with mental illness and the social components of vulnerable segments of each society. They are stigmatized, often suffer from discrimination and exclusion in any social setting, and this increases the probability of violation of human rights. Mental disorders of such persons may sometimes have an adverse effect on their ability to make decisions, and they will not always seek or consent to undergo treatment. In rare cases, due to the reduced functional capacity to make solutions, people with mental disorders may be a danger to themselves and to others. Common misconceptions on this subject should not affect the essence of the legislation in the field of mental health. Legislation in the field of mental health can serve as a legal basis for consideration of critical issues, such as the integration into society of persons with mental disorders, providing high-quality care, increasing access services, protection of civil rights, as well as the guarantee and promotion of the rights in other key areas of life, including housing, education and employment. In addition, the law can play an important role in the promotion of mental health and prevention of mental disorders. Here we are to speak about the mental health in Aotearoa and compare it to Maori medical and recovery perspectives. As we know, the Aotearoa is the Maori name for New Zealand.
Firstly, it should be mentioned, that Maori was formed as an ethnic group long before the discovery of the archipelago by a Dutchman Tasman. Europeans since the time of Captain Cook treated Maori with disgusting – like a grim and warlike cannibal with armed resistance for every piece of their homeland. Maori subsequently suffered a tragic fate. The rich spiritual culture and complex religion were destroyed, ancient traditions ruthlessly trampled upon, and the whole nation was deprived of both their roots and identity and a meaningful future in the world of the white man. In the social structure of modern New Zealand Maori occupy a percentage worthy only of defining a living museum relic, and nothing more. That is why, when we discuss mental health issues concerning Aotearoa New Zealand we must take into consideration the interaction of spiritual, emotional/mental, physical and family health in the Maori’s beliefs.
Traditional beliefs of Maori did not separate the use of magical healing from herbs and saw it as a part of a whole, where the effectiveness of one was not possible without the other. The plants were used for medicinal purposes and as an essential element of support in healing rituals, along with fire, water, and karakia – those who read the special spell. The treatment of some diseases was possible without herbal remedies, only with ritual and prayers. It should be underlined that Maori has a specified philosophy towards health that is based on a holistic health model or wellness. To maintain good health is often associated with excellent religious practice. It is also important that Maori explain health as a concept of four basic life beliefs: Te Taha Hinengaro (psychological health), Te Taha Wairua (spiritual health), Te Taha Tinana (physical health), and Te Taha Whanau (family health)(Fraser, 2010). The most essential requirements for health in their opinion to be in close relation with the spiritual world, have harmony in thoughts, feelings, and behavior. They believe in Space and respect family. That is why it is very difficult to diagnose mental disorders of such ethnic minorities, as doctors cannot even investigate the case of schizophrenia or other diseases due to the unusual cultural peculiarities of those people.
Meanwhile, scientists prove, that ethnic minority (immigrants or colonized natives) are at much higher risk of a diagnosis of schizophrenia than members of the dominant culture. This was demonstrated in most countries of the world such as Australia, Belgium, Denmark, Germany, Israel, the Netherlands, and New Zealand (Sachdev, 1997), the UK and the U.S. These figures are only partly explained by the higher limit in terms of assumptions. For example, in New Zealand Maori patients are diagnosed with “schizophrenia” twice often than Europeans (Te Puni Kokiri, 1993).
During a recent study in New Zealand, which was attended by 692 psychologists and psychiatrists, respondents were asked the following question: “In your opinion, why the majority of patients in mental institutions are members of the Maori?”. In most cases, the answers to explain this fact referred to colonization, loss of their land and language, and poverty. However, 18.5% of psychiatrists men (but no women psychiatrists and a psychologist, a man), said that this was the result of increased biological or genetic predisposition of the Maori to mental illness when compared with Europeans. Answers, for example, were: “Genetic burdened”, “Bole Maori biologically vulnerable”, “genetically Maori culture has a predisposition to mental illness,” “The representatives of small nations/cultures are more prone to mental illness than Europeans” (Johnstone and Read, 2000, p. 142).
Similar views were typical for the majority (61%) of the male psychiatrists, native-born of New Zealand, clinical experience of which consisted of ten years or more. However many skilled psychiatrists tell that “racist interpretations have no explanation, and much more likely that the Maori mental health is related to social factors” (Johnstone and Read, 2001).
Another explanation of regularly mental disorders of Aotearoa is diagnostic errors that often happen due to cultural differences. Experts cannot make a distinct line between the normal and abnormal in other cultures. Maybe it is. However, this approach rejects another principle of the medical model: schizophrenia is a biogenetic disease and is not related to the violation of cultural norms. Thus, this leads to the conclusion that “crazy” for whites may be the “norm” for other minorities. It may take a dangerous assumption that “Maori culture” is not just difficult to understand, but it also provides fertile ground for “mental illness” (Agee, 2012 ).
All this attention to the “diagnostic errors” may be more directed to the avoidance of social or psychiatric problems of racism, rather than the way to improve the situation. Psychiatrists representing the dominant culture around the world, in spite of all the results obtained in the course of the research, did not abandon their previously established lists of symptoms and diseases, which they used in assessing the status of members of other cultures. They did not even make the changes there. In New Zealand, only 1% of 13% of psychiatrists and psychologists recognize that the “European system of diagnosis should not be used against Maori persons” (Johnstone and Read, 2000).
In addition, in respect of members of ethnic minorities, the label “schizophrenic” is more often used, and they are more likely to be treated in other ways. Immigrants, colonized natives, and other minorities more often, in comparison to those of the general population (or, by comparison on “clinical examples of” psychotic or hospitalized patients), subject to involuntary admission and retention in the hospital. In addition, for involuntary hospitalization, law enforcement forces are often involved, and these patients are often placed in protected special clinics rather than in private hospitals. Moreover, they are more likely prescribed anti-psychotic drugs or electroconvulsive therapy and are not offered to use psychotherapy.
The data obtained as a result of the study involving 200 outpatients in New Zealand have shown that persons of non-European origin (mainly Maori and Pacific peoples) are more likely than Europeans applied the Law on Mental Health (Mental Health Act). They are more often subjected to forced hospitalization than white citizens are.
As to the structure of mental health, today every Health Board in Aotearoa New Zealand offers several forms of peer support that is a part of a developing commitment to set ‘recovery’ in the mental health system. We have to distinguish between the two forms of recovery concerning mental disorders and illnesses. The first form of recovery, in other words, is a restoring of the previous functioning in addition to reducing symptoms. The second form of peer support is based on the civil rights of each person to live well, to have an independent life, and mental health consumer’s movements. That means the coordination of work of various organizations, that has a goal to provide effective peer support, based on trust, care, and understanding, improving living conditions and self-determination. This work has several levels and aims to coordinate practical to spiritual issues.
In Aotearoa New Zealand, the peer support movement origins in the mid-1970s, when one of the former mental patients started to help fellow consumers. Volunteer peer support even now is primarily based on that empirical understanding.
Peer support links were established in two M?ori orientated services during whakawhanaungatanga (that is the name of the process of establishing relationships). That seems to be the ancient form of peer support. Participants prove its effectiveness; which underlines the fact of empowerment happening on a diversity of different levels. There is an increasing confirmation that peer support reduces hospitalization, leads to improvements of living circumstances and quality of life. However, there is always a risk of suicide, self-harm or harm to other people that can happen in some cases. That all demands further studies and developing approaches for handling risk.
Peer support disagrees with the ‘ideal type’ of the medical model in a number of ways. Firstly, it is focused more on recovery. Secondly, it is potency-based, more than on symptoms, diagnoses, and pathology. The aim of the relationship is unswerving by the peer and not the peer supporter. In such a situation, there is a disagreement with the medical system as peer support works on dissimilar principles.
In conclusion, it should be said, that Aorearoa’s health beliefs, especially concerning mental health, differ from the European models. That is why the answer is in a transcultural medical theory. People from different cultures really have dissimilar kinds of claims in terms of health. It is a vital human right for each person to express without restraint his own cultural values. People with contrasting cultural values are to be respected, and this fact should be taken into consideration when working strategies for health care are supplied. That is why Leininger and other scholars underline that transcultural nursing models are an excellent guide for the nurses, and give an opportunity to get acquainted with the different multicolored cultural structure of the society( Leininger, 2006).
On the other hand, some spots in such a theory are also related to their weaknesses. Currently, transcultural nursing theory is a high risk for nurses, as there will always be some misunderstanding between people of different cultures. The theory has failed to take into account the socially constructed nature of culture, and in doing so, avoids addressing the historically driven social practices in health care, which have led to the oppressive practices.
The tradition of health services differs among races and varies depending on geography, culture, income, and kind of health care treatment. Based on their own history and practice, many Maori observe getting health care as a humiliating, demeaning or embarrassing practice. Some may even panic or show antipathy towards health or mental health clinics, due to the reason such as time-consuming waits, medical jargon, racism or separation, loss of identity, and a feeling of alienation and powerlessness in the system. Provision of the mental health care to Maori of older generation must give contemplation to culture and customs, with the acknowledgment that social and relationship networks, society, extended family and the religious beliefs are all noteworthy players in the support service system and health care.
We also have to mention the impact of colonization on mental health services development and on the Maori health. Colonialism is a determinant of health as predetermines
unequal relationships, that have real negative effects on health. Accordingly, colonization influenced on Maori lives as many-sided. From a perspective of mental health, colonialism resulted in numerous mental health discourses, and its effects can be viewed as a response to contemporary political, economic and social, situations and historically through trauma. Investigating the enduring effects of colonization, decolonizing Maori mental health discourse, we make a conclusion that it allowed for just and sufficient control over key scopes, such as health services, that improved health.
Historically the following trends in the development of mental health in Aotearoa New Zealand were formed:
• Development of Mental health nursing;
• Occupational therapy;
• Social work.
To be more specific, the Pacific perspectives on mental health are directed to meet more effectively all existing mental health needs of Maori people and to make a full understanding of the Central Pacific perspectives on mental health.
Currently, the mental health in New Zealand is basically supported by the holistic outlook of health taken into custody by the Fonofale model. This model is very close to the Maori culture as it incorporates ideas and values that intimately relate to family, culture, and spirituality.
One of the most significant trends in the development of a new, more effective model for mental health that touches the problem of Pacific services. However, today there is no straightforward definition of a Maori mental health service. Some key elements are present, and that gives a chance to build an effective mental health structure. There are basic elements of government involvement in the management of the service, supply with professional staff, development of a service basing on New Zealand minority’s beliefs and values, and the most important thing is providing for Aotearoa people mental service in culturally appropriate ways.
To make a conclusion, we must underline that because people in New Zealand come from different and unlike diverse groups, the mental health system must be developed based on this fact. Specific traditionally built ideas influence Maori people; the ideas differ from contemporary ones. The model of mental health must, therefore, take into account both sides and adopt modern trends to traditional cultural values and perspectives.