Book Review: Maea te Toi Ora Māori health transformations, by Simon Bennett, Mason Durie, Hinemoa Elder, Te Kani Kingi, Mark Lawrence and Rees Tapsel

cv_maori_health_transformationsAvailable in selected bookshops nationwide.

Maea te Toi Ora Māori Health Transformations is an introduction to a framework for thinking about and transforming Māori mental health based on Māori values, and a strong case for the transformative potential of practice guided by this framework. It is a history of the assessment and treatment of mental illness in Aotearoa, and the policy transformations that have arisen from the realisation that a Māori response may be best suited for Māori mental health needs.

Although oriented towards Māori mental health, the text is absorbing for anyone with an interest in mental health, health policy-making, indigenous conceptions of health and treatment models, or the use of case studies in research. Although six authors collaborate in this work, their shared commitment to this framework means the text is a cohesive whole. Some of the authors are architects of this framework, and all are recognised practitioners.

From their respective disciplines, the authors analyse the impact of alienation from and reconciliation with identity on different dimensions of well-being. Some areas are addressed by several authors from their respective disciplinary backgrounds, and this iteration helps to ground concepts unfamiliar to the non-specialist reader.

The text can also be read as a handbook for steering policy change, and provides an insight into the philosophy behind the Whānau Ora policy. One of the authors, Mason Durie, chaired the Whānau Ora taskforce.

Before they illustrate their application of the framework with individual cases, the authors trace the whakapapa of this philosophy grounded in Māori values with its roots in traditional practice. They acknowledge the trailblazing practitioners who have ensured this model’s long-term viability, despite changes in government policy.

Durie’s Te Whare Tapa Whā, or four cornerstones of wairua (spirit), hinengaro (mind), tinana (body), and whānau, is the conceptual heart of the book and its unifying thread. In this framework, mental illness is not isolated dysfunction, but an imbalance between emotions, relationships, spirituality and body. The ultimate goal is mauri ora –a life force flourishing spiritually, mentally, physically and socially.

An example of a model presented in the text is Hinemoa Elder’s Waka Oranga/ Waka Kuaka, presented in a chapter solely in te reo. Combining metaphors of waka and flocking godwits (kuaka), practitioners and whanau work together towards health goals and provide mutual support to reach the destination: the well-being of patient and whānau. To translate (and paraphrase) some of the principles behind the model: The whole whānau is the patient, mātauranga Māori is a source of remedies, identity is at the heart of well-being, making contact with a person’s roots is medicinal.

These principles recur throughout the text, as does the outcome of healing wounds in the psyche by reconnecting the patient with their identity. This process is nurtured through bonding with the professional, applying the wisdom transmitted through whakataukī (traditional knowledge encapsulated in sayings) and healing rituals. Case studies are the preferred analytical tool and methodological foundation, and ensure the reader does not lose sight of the purpose of this framework: the well-being of people and their communities.

The case studies emphasise positive outcomes and transformative potential. They are either direct adaptations of an individual interaction or the merging of several cases to create an archetypical patient. This knowledge arises from whakawhanaungatanga with the tangata whaiora (identification of common ground between practitioner and patient). Elder even extends the application of case studies to geographical places, incorporating the impact of historical scars on the landscape on the mental health of those who live nearby.

Some make for fascinating reading, such as one case in which mental illness coexisted with deeply held Māori spirituality. In this case, the guiding philosophy described in this text facilitated a treatment able to secure the patient’s well-being without undermining their beliefs.

The authors prefer tangata whaiora, literally “health seeker,” over patient or consumer. However, the authors recognise that the purchasing model of health has enabled Māori providers to flourish and means government can contractually require health providers to incorporate Māori priorities, such as whānau engagement, te reo and tikanga, karakia, rongoā (medicinal herbs and therapies), and access to tohunga or healers.

A central theme is that Māori well-being can be achieved by considering a Māori worldview, which the text broadly conceptualisies as one in which personal identity makes sense beyond the individual. The authors stress that not all Māori have or wish for the same connection with te ao Māori, which is why the text does not advocate for a universal approach for all Māori.

Although the overall tone is optimistic and inspiring, the authors acknowledge the challenges of implementing a Māori framework for Māori mental health. Rees Tapsell speaks of the burden Māori practitioners can bear if they are an institution’s sole source of mātauranga Māori. He recognises the benefits of cultural programmes, but highlights that often only a few knowledgeable staff can implement them. He also warns of treating these programmes solely as a didactic tool rather than a guiding treatment philosophy.

Similarly, Elder meditates on the challenges of meeting legislative provisions to engage whanau, hapū and iwi, and observes that they can only bear fruit if the practitioner has the knowledge and commitment to engage with these groups on their own terms. She poses questions for practitioners that help them understand tangata whaiora and their communities, and her case studies demonstrate the rewards for both practitioner and patient when these provisions are fulfilled in the true spirit of the concepts they invoke.

This text is compelling because it puts its philosophy into practice: it acknowledges history of people and place, it is built on dialogue, and its recommendations are guided by mātauranga and supported by whakataukī. Encouragingly, it shows even timid steps towards biculturalism in service provision can support and empower giant leaps by visionary practitioners towards a more responsive framework for Māori.

Reviewed by Paul Moenboyd

Maea te Toi Ora – Māori health transformations
by Simon Bennett, Mason Durie, Hinemoa Elder, Te Kani Kingi, Mark Lawrence and Rees Tapsel
Published by Huia Publishers
ISBN 9781775502975