Nor do Māori mental health providers take a segmented approach to health care, delivering only “mental health services” as defined by medical models. Respondents noted that Māori take a holistic approach to healthcare.
I think Māori providers because they see things in a more holistic way, that ...
they're making the connections. Most Māori providers won’t say ‘I am just
seeing you for this interaction and I will ignore the rest of your environment’. They’re saying ‘I’m seeing you here for this purpose and I note all the other
So I think the reason that they address the wider issues and don’t focus only on the terms of the contract is because they’re not very good at unbundling the terms of the contract from the person they’re talking to. It’s the holistic view,
they intuitively respond to. I don’t think that’s necessarily about being Māori
because a number of other providers do that as well. They’re not very good at seeing something in isolation. Health professionals are very good at it.
KI15:12
We don’t work like the segment of a pie ... A psychiatrist will look at mental illness and a diagnosis. He will prescribe medication. We look at the whole person and ... look at well, ‘what’s happening within your circle that’s making you go like this’, you know? So we ... don’t deal with just one. You can’t otherwise you’re missing a link, you know? That’s my philosophy and that’s how I work. Yeah. We don’t look at the segment. They have a psychologist to look at that area, they have a social worker to look at that area, they have a psychiatrist that looks at that area, the PDN that follows up is over there, you
know and the Māori health worker comes along and does all that anyway.
KI01:3
If you say that Māori providers do more than is expected of them then you’re
absolutely right and why I say you’re right is because Māori working in that
field work in the whole person. The non-Māori view of mental health is some
block in the brain and they don’t take into account in terms of that brain not
functioning properly being associated with any other part of the body ... Māori
cannot isolate the biological body from its spiritual dimensions. Now those
spiritual dimensions are what we term hinengaro and wairua. KI12:1
Tikanga
Māori providers might also do more because they are bound by “a whole other set of rules that others don’t [sic] and that’s called tikanga” (KI17:5). These rules compel Māori providers to do additional work, to carry out additional tasks and to care for people in a different way from that of mainstream providers. Another respondent, in discussing this point noted:
You look at our kaumātua, why do they go the extra mile when they’re supposed to be retired? Where have we had our learning from? You know. Who’s gone in front of us? Who have set the patterns before us? We haven’t created it, it’s not new, from here. You know, this has been a part of our culture, part of our heritage. It’s been handed down to us. We always go the extra mile. Why? Because the other ones in front of us did that as well. So it’s not just mental
health it’s across the board. KI01:12
Another respondent agreed noting that the reason Māori mental health providers do more can be found in Māori values and the values of one’s ancestors.
You know why do we do it? ... let me answer it this way ..., what is the tikanga of
our service and our whānau here? That's how I answer it. What is the tikanga?
Because tikanga is based on manaaki, it’s based on aroha, its based on wairuatanga. Now I can’t see any of that sort of terminology in DHB/Ministry
documentation. And those other things that our tūpuna got brought up on.
They don’t get brought up on being financially secure, and you know being able
to measure ... working capital ratios and liquidity ratios. KI08:12
This explanation is closely linked to the comments of another respondent who observed that Māori mental health providers not only did work that was additional to their contracts, but that their method of working was completely different to that of mainstream providers and in fact unique to Māori.
It’s that wairua stuff eh? That’s the big difference. Westernised, western world don’t have that. They don’t know how to deal with that, they don’t understand it. So there’s another difference ... The different way is the whanaungatanga stuff, that unity, the family unity. Looking after the whole spiritual side and the spiritual side is not just religion ... Acknowledging the whole rather than segments of the pies. Allowing them to be people not patients, they’re a person
first, you know, who happens to be Māori and whatever else follows, with a lot
of guidance. You know we do manaaki really good…Manaaki, tautoko, awhina,