Guest Editorial
By Bernard Te Paa
Bernard Te Paa (Ngati Whatua, Te Aupouri, Nga Puhi, Waikato) has been General Manager Maori Health at Counties Manukau DHB since May 2003. Prior to this he was employed in a number of different roles with Waitemata DHB, including working with Maori running education and training programmes, developing the regional Maori Alcohol and Drug programme, and the Orion Project, the Waitamata DHB building programme. Bernard has a BA in Maori and Education and a postgraduate diploma in business. He is married with three children.
E nga mana, e nga reo, a nga karangatanga maha o te motu, tena koutou, tena tatou katoa.
Anei ra he pitopito korero hei timatanga mo te tuhinga nei a te Roopu Oranga Hinengaro. I tenei wahanga o te tau, ko Matariki, e tika ana ki te whakamaumahara i nga mahi tokomaha o Ngai Maori i te Ao Hauora, Ao Oranga Hinengaro nei.
In writing an editorial that builds on the Maori oriented theme of this issue, I am immediately reminded of those who have contributed to the development of the Foundation who are now not here, and in particular the acute sense of loss, the mental health community felt with the untimely death of Mahinarangi Tocker.
No one person better illustrated the twists, the turns and the triumphs of living with mental illness than Mahinarangi. To be able to then share her story with the world and to work with others to raise mental health consciousness above the fear and trepidation levels of current society, shows how much we have lost. Moe mai ra e te tuahine, i roto i to waka aroha.
In discussing Maori health and in particular health promotion, I concur with Dr Mason Durie that a discourse about Maori health gain is actually about being Maori in the 21st century. And to be Maori in the 21st century, you need to be clear that significant portions of Ta Apirana Ngata's quote, "E tipu e rea" are still relevant. In particular, that the world of the Pakeha influences your physical being, your socio-economic status, and challenges you to set aside your cultural standards as set down by your ancestors in the pursuit of physical goals. These imbalances can be seen in modern history, and be loosely termed, colonisation.
But while historically we have been pre-disposed to concentrate on under-achievement, or poor Maori responsiveness I would like to also acknowledge our successes, what the mental health community have built.
Successes such as the adoption of Te Whare Tapawha and other Maori models of practice, are the result of consistent challenging of the clinical model of practice. Another success - the inclusion of whanau in the full continuum of care - has been a win for Maori and non-Maori, as has been the inclusion of consumers in service development, delivery and evaluation.
The coming together of mental health and health promotion has historical significance for Maori. The concepts of tapu and noa are the basis of traditional health promotion, which have stood resolutely for hundreds of years.
From them, spring specific health promotion and prevention enablers such as rahui, rongoa and karakia. Tapu, noa rahui, rongoa and karakia are all components of a traditional health approach. They acknowledge the sacred and profane states of health, and passive and active health interventions.
People like Sir Maui Pomare, the first Maori medical practitioner, and Medical Officer for Maori in the Department of Public Health in 1901, provided both national leadership and local initiative in establishing a benchmark for Maori health gain. He based this on five key points:
- Maori leadership is required to make gains in Maori health
- Health is inextricably linked to socio-economic well-being, so we need solutions that deal with both issues
- Long term mental health gains need to be linked to adaptations in cultural norms
- Long term mental health solutions need to be community oriented
- Skilled health workers who were comfortable in clinical and community settings were needed to support Maori leadership.
These key points still have relevance in our world today, some have increased in terms of their priority, all play a role in driving mental health promotion. Maori leadership remains enigmatic, with the burden of responsibility placed on a few, and the need for succession processes to be put in place.
While there is general agreement that health and socio-economic well-being are intertwined, we continue to take a single issue approach to solutions, and miss the opportunity for real gains in both areas, in the quest for patch protection.
Culture continues to change slowly, indicative of the conservative nature of Maori (neither, negative or positive). Mental health promotion has yet to realise its potential impact on culture and in particular tikanga. We see it occurring sometimes in haka or waiata, but I await the day when we can talk openly on the Marae about whanau who deal with mental health issues. In talking about culture, we need to be clear that mental health promotion has to embrace tikanga requirements from the onset, not as the "politically correct" necessity we sometimes tack on at the end.
Our current workforce shortages, which everyone is working on exemplifies the intersectoral solutions required. As with the previous comment, succession planning needs to be formal and supported. The adage, "Short term pain, long term gain" notes that mental health promotion has benefited from sector leaders, Maori and non-Maori. While not the best example currently, given the controversy, the Mental Health Commission has provided some of the required sector leadership. Let's hope they see the light of consumer sunshine in due course.
Participating in the mental health field and in particular health promotion, continues to be exciting and rewarding. The advances we are making, in mental health, in Maori health, are beneficial for the country as a whole.
Tawhiti rawa tou haerenga ake te kore haere
tonu
Nui rawa ou mahi te kore mahi rawa
We have come too far not to go further
We have done too much not to do more
