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When the whaiora falls over the whaiora is blamed and not the model. Why don’t we match the client with the right service? (Kaupapa Māori service provider)

In hui with Māori, on marae and in community meetings, we heard from Kaupapa Māori providers and Iwi that they are achieving good outcomes for tāngata whaiora through initiatives like the project run by Te Taitimu Trust in Hawke’s Bay, helping rangatahi at risk to develop resilience and wellbeing.

Overwhelmingly, submissions from Māori said that the health and wellbeing of Māori requires recognition of indigeneity and affirmation of indigenous rights. They argued that our approach to mental health needs to acknowledge the Tāngata Whenua status of Māori under Te Tiriti o Waitangi. In addition to more Kaupapa Māori services and a strong Māori mental health workforce, many Māori want to determine how services are commissioned, delivered and evaluated.

The responses and solutions reside in the realisation of Treaty guarantees and whānau, hapū, iwi rangatiratanga/self-determination. (Whānau group)

We were told that the Western model of mental health, enshrined in the health system and legislation, is based on beliefs that are not shared by all Māori and are not always helpful – for example, the separation of mental health from oranga (health and wellbeing) is contradictory to holistic understandings of health.

Māori identity is rooted in whakapapa, tikanga and kawa. (Māori leaders)

Māori organisations are surrounded on all sides by non-Māori perspectives. There is conflict between Western and Māori ideas of best practice. (Group of Kaupapa Māori providers and tāngata whaiora)

Many Māori pointed out that current mental health services, strategies and policies do not reflect a genuine partnership between the Crown and Māori. They argued that the way our health system approaches mental distress and illness reflects a colonising world view largely hostile to Māori understandings of wellbeing. They spoke of compulsory treatment as a threat to mana and to their ability to live as Māori.

We heard that recognition of the importance and significance of ties to whānau, hapū, iwi and family group, including the contribution those ties make to wellbeing, and proper respect for cultural and ethnic identity and language29 rarely form part of psychiatric assessments. They are routinely not addressed by courts, tribunals or others when making decisions about compulsory assessment and treatment. We also heard that patients are denied their entitlement to be dealt with in a manner that accords with the spirit of proper respect for cultural identity.30

Māori explained that their mental health has suffered as a direct result of a long-standing alienation from their land and the impact of colonisation and generational deprivation. They said that reclaiming mental wellbeing requires reconnection to land, culture, whakapapa and history, but many mental health and addiction services barely acknowledge the importance of this connection and thus reinforce trauma.

Those who cannot understand or connect to the lived experiences of intergenerational historical trauma, of resilience in the face of life threatening adversity, of dignity scorned and beaten out of us, simply have no business advising tāngata whaiora on how to live their lives. (Kaimahi Māori)

Māori hoped this Inquiry would prompt the Crown to re-engage with iwi, hapū and whānau on issues central to the future wellbeing of Māori and their right to live as Māori.

At the heart of current Māori ‘un-wellness’ is colonisation, institutionalised racism, unconscious bias and a western model of wellbeing, with systems that strengthen that model and perpetuate further inequity than those already experienced by Māori. (Māori NGO providers)

29  As required by the Mental Health (Compulsory Assessment and Treatment) Act 1992, section 5.

30  Mental Health (Compulsory Assessment and Treatment) Act 1992, section 65.

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