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Evaluating Te Reo Tuakiri : acceptance and commitment therapy in a schools-based resilience programme in Aotearoa : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
(Massey University, 2024-08-08) Burt, Regan
The mental health of Aotearoa’s (New Zealand) rangatahi (young people) has received considerable attention in recent years due to increasing rates of psychological distress and suicidality. Evidence shows these difficulties are greater for Māori and Pacific rangatahi and those living in low socioeconomic areas. The New Zealand government’s 2018 inquiry into mental health recommended implementing early intervention programmes in schools to help rangatahi learn about mental health and develop skills to build their resilience. One such intervention is Te Reo Tuakiri, a new resilience programme offered to rangatahi in secondary schools across Aotearoa. Run by the bi-lingual social impact organisation M3, the content of Te Reo Tuakiri is informed by Te Ao Māori (Māori worldview) models of wellbeing and acceptance and commitment therapy (ACT). The programme utilises a tuakana-teina (relationship between an older person and a younger person) approach, whereby the rangatahi learn resilience skills and pūrākau (Māori legends) which they then go on to teach to tamariki (children) at a nearby kindergarten. This thesis evaluated the Te Reo Tuakiri programme’s inaugural offerings in two secondary schools in Tamaki Makaurau (Auckland). The aims of this evaluation were to investigate the effect the Te Reo Tuakiri programme was having on participant resilience and psychological flexibility and to investigate participants’ experiences, understandings, and practices of ACT processes as taught in the programme, alongside their cultural applicability. To achieve these aims this research took a mixed-methods approach to evaluation and involved the quantitative analysis of measures of resilience and psychological flexibility at three time points, alongside thematic analysis of focus groups with students and facilitators following completion of the programmes. The main findings of this study showed improvement in participants resilience from pre- to post-programme with a medium effect size. However, the participants did not see a significant difference in their psychological flexibility across the programme (pre to post), though there was a medium effect size from pre- to mid-programme. Further, no significant correlation was found between measures of resilience and psychological flexibility at any of the three time points. The qualitative portion of this study helped to provide some context to these findings. The themes generated highlighted instances where students provided evidence of several ACT-congruent perspectives that were beneficial in helping rangatahi better manage their private experiences and act on these newly developed skills. However, there were also instances where students expressed ACT-incongruent perspectives. The qualitative analysis also provided support for the programmes cultural applicability and demonstrated the successful adaptation of ACT processes for a Māori cultural context. Taken together, these findings demonstrate support for the Te Reo Tuakiri programme as an effective resilience intervention and adds to a small pool of research indicating ACT may be an appropriate intervention for addressing the mental health needs of rangatahi in Aotearoa. Limitations of the present study as well as recommendations for Te Reo Tuakiri and areas of future research are also presented.
Whānau Māori and their experiences of attention-deficit/hyperactivity disorder : implications for clinical practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand
(Massey University, 2023-06-30) Tipene, Charlene Mereana
Health care in New Zealand (NZ) is based on the ideal of universal health coverage for all. However, for many Māori health inequities exist in health outcomes and in access to services which adequately meet the needs of whānau Māori. Researchers have considered explanations (and solutions) for this situation, including whether health services are able to meet the cultural needs of Māori clients through a more holistic approach. Rather than considering this generally for all services, this research considers this specifically in relation to Attention-Deficit Hyperactivity Disorder (ADHD). Alongside core symptoms of hyperactivity, impulsivity, and inattention, for there to be a diagnosis of ADHD there must be associated functional impairment and diffuse impact of behavioural symptoms in multiple domains of a person’s life. This means that ADHD is well suited to the application of holistic understandings of wellbeing, such as those that exist in mātauranga Māori. A lack of research about ADHD among Māori highlights a need for research which explores the experiences of tamariki Māori and their whānau as they navigate ADHD diagnosis and treatment. This research used a Māori-centred framework and throughout, was guided by He Awa Whiria (Gillon & Macfarlane, 2017) which emphasises the importance of drawing together cultural and clinical knowledge. There were three main objectives: to understand the experiences of whānau Māori with a child assessed and treated for ADHD; to describe how whānau understood and accommodated ADHD behaviours before diagnosis; and to identify any barriers or facilitators for whānau Māori in accessing assessment and/or treatment. Semi-structured interviews took place with 10 whānau members, representing 13 young people who had been diagnosed with ADHD. The interview responses were analysed using (codebook) thematic analysis. The main findings revealed firstly that there were different levels of knowledge about ADHD among caregivers and some whānau struggled to know where to begin, to get support; secondly, it was difficult to access the service, and there was a lack of ongoing support available other than medication; and thirdly, while in all cases medication was offered as treatment, whānau found this a difficult decision to make for their child, preferring a more holistic approach. Most whānau were not asked about their cultural background or beliefs during assessment and half of the participants would have accessed a kaupapa Māori service if available. The implications of the findings for clinical practice are discussed with recommendations for how to blend cultural and clinical knowledge to ultimately benefit whānau Māori and achieve the best possible outcomes.
The effectiveness of a guided low intensity cognitive behavioural therapy programme with adult Māori experiencing low mood in a community-based setting : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
(Massey University, 2022) Elkington, Angus Marangai Brons
Common mental health disorders such as depression is a leading cause of ill health and disability. The global problem is underscored by a lack of access to evidenced based psychotherapy and under resourced workforce. Low intensity Cognitive Behavioural Therapy (LI-CBT) within a stepped care approach is one way to alleviate the burden of mental health and increase service delivery. LI-CBT Studies have been conducted in New Zealand and were effective at treating mild to moderate depression with non-Māori groups and across individual and group formats. However, studies investigating the effectiveness of Cognitive Behavioural Therapy (CBT) with Māori are sparce considering that Māori are at increased risk of poor mental health outcomes. This study investigated the effectiveness of an unadapted individually delivered telephone guided LI-CBT programme, Living Life to the Full with Māori adults using longitudinal multilevel modelling. The current study monitored change in low mood, psychological distress and quality of life enjoyment and satisfaction across 13 time points, which consisted of three weekly baseline measures, eight weekly measures during the intervention and one a six- and twelve-weeks post programme. A total of 20 participants of Māori descent were recruited in which 18 participants completed the Living Life to the Full programme. Multilevel modelling and the variable of time explained a significant portion of variance to provide more conclusive evidence to suggest that on average participants experienced significant improvement in low mood, psychological distress, and quality of life enjoyment and satisfaction comparative to similar LI-CBT studies. The current study fills a void in the literature and supports the effectiveness of low intensity Cognitive Behavioural Therapy (CBT) for Māori experiencing low mood, when delivered by a Māori facilitator. Therefore, the implementation of LI-CBT programmes such as Living Life to the Full can provide greater access, preference, and choice to evidence-based interventions for Māori experiencing low mood.
Ko wai, ko wairua : narratives of wairua and wellbeing : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
(Massey University, 2022) Brittain, Eleanor
Wairua is a fundamental, boundless, and connective aspect of Māori ways of being and the significance of wairua to wellbeing is reiterated in foundational models of health. The research sought to understand Māori narratives and meaning-making of wairua pertaining to experiences of mental distress, healing, and recovery. This entailed developing a Kaupapa Māori narrative approach, to embed the research within Māori worldviews, to draw from mātauranga, and to amplify the relevance and meaningfulness of the research processes and outcomes. Kaupapa Māori theory was the interpretive framework, determining and shaping the research foundations, narrative inquiry informed the methodology, and the research processes mirrored Māori rituals and ways of engaging. Recruitment occurred through Māori networks and used a snowball approach. Twelve Māori adults, who at some time experienced mental distress or accessed mental health services, took part in one-on-one interviews. Narrative interpretations were undertaken at an individual level and as a collection of narratives. The overarching narrative interpretation is laid out in three components, arranged around salient and meaningful metaphors. Firstly, ‘Te pō, te ao mārama’, darkness and light, emerged from the narratives as a metaphor for experiences and temporal phases. Secondly, ‘Aro atu, aro mai’ figuratively conveys a continuum of distance and closeness; it is used to illustrate and represent the qualities of the relationship with wairua. Thirdly, ‘Ko wai, nā wai’ draws on the recurrent narrative imagery of water, as a metaphor for the contextual nature of identity, focusing on the significance of Māori identity and relationships with others. Narratives of wairua entailed a retelling of experiences as Māori. Distress and despair were inevitably experiences of wairua and characteristic to healing and recovery was enriching wairua. Moreover, healing and recovery were inherently relational and enhanced through connections with whānau and collectives.
Mā tō tātou whanaungatanga e whakataki i te ritenga tika : Māori mental health service engagement : a narrative woven by tāngata whaiora, whānau members, and Māori kaimahi : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
(Massey University, 2020) Backhouse-Smith, Amelia Jade
Uplifting Māori mental wellbeing is a priority in Aotearoa with major national studies revealing Māori experience persistent and growing disparities in mental health outcomes. Notably, the mental health sector lacks explanations for the significant finding that Māori seek less help from mental health services despite the prevalence of psychological problems. Following a Kaupapa Māori Research approach, this research sought to understand why service engagement was incommensurate with mental wellbeing needs among pakeke Māori and offer recommendations for how mental health practice could evolve to address this outcome. Semi-structured interviews were carried out with five tāngata whaiora, three whānau members, and four Māori kaimahi. The perspectives of these three rōpū were privileged as they reflected those with lived experience of engaging with, or carrying out mahi in, mental health services. Interview kōrero was analysed and developed into themes using thematic analysis. The collective perspectives of tāngata whaiora, whānau members, and Māori kaimahi were integrated within a narrative about how mental health care experiences influenced Māori service engagement. Findings spoke to the importance of practicing within Te Ao Māori which involved upholding tikanga and mātauranga Māori, acknowledging cultural identity, facilitating reconnection with Māoritanga, and being whānau-centred in mental health care; developing genuine and meaningful relationships with tāngata whaiora and whānau; encouraging openness, support, and literacy around mental wellbeing; empowering Māori voices in assessment and intervention; and appropriate mental health sector resourcing. This research can help the mental health sector begin to understand why Māori seek less help from services and provide culturally and clinically responsive solutions for how mental health practice can support and improve service engagement to uplift Māori mental wellbeing.
Ngā mea kōaro o ngā wā tamarikitanga, te taumahatanga o aua mea me ētahi mahi whakaora hinegaro mō ngā wāhine Māori = Adverse childhood experiences, HPA axis functioning and culturally enhanced mindfulness therapy among Māori women in Aotearoa New Zealand : a dissertation presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand
(Massey University, 2019) Ketu-McKenzie, Miriama Deborah
Chronic health conditions such as obesity, type II diabetes, cardiovascular disease, depression and anxiety are prevalent among Māori women in New Zealand, as are adverse experiences in childhood and chronic stress. Recent studies have shown a link between adverse childhood experiences (ACEs) and chronic health problems later in life. Many of those studies propose that dysregulation in the stress response system - specifically the hypothalamic-pituitary-adrenal (HPA) axis - mediates that link. Cortisol is the primary corticosteroid released by the HPA axis and is commonly used as a biomarker for assessing HPA axis functioning. Mindfulness-Based Stress Reduction (MBSR) is a therapy that uses a range of breathing techniques, stretches, formal meditations and awareness exercises designed to help regulate the stress response by changing the way the brain manages and relates to stress. Due to its Eastern roots, MBSR therapy assumes an holistic view of health that mirrors some of the key concepts promoted in Te Ao Māori. This research tested the HPA axis functioning of eight adult Māori women who had experienced high ACEs, and explored associations between cortisol dysregulation, visceral obesity (a risk factor for many chronic health conditions) and psychological distress. This research also tested the clinical effectiveness and cultural responsiveness of an MBSR course that had been enhanced to suit a Māori audience. Participants provided pre, mid and post-treatment salivary cortisol samples that measured changes to their acute stress cortisol response, as well as changes to their daily cortisol slope, their cortisol awakening response and their overall cortisol levels. They also provided pre and post-treatment waist circumference measurements. Self-report data assessing depression and anxiety levels, PTSD levels, stress eating habits, perceived stress levels and mindful awareness levels, was collected, as was qualitative data in the form of pre and post-treatment interviews. The results indicated that culturally enhanced MBSR therapy was well received with this sample of Māori women and that the participants reported a wide range of benefits as a result of practicing mindfulness meditation.
Seeking solutions to being restricted : a Māori-centred grounded theory of Māori, mental illness and health services : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Studies, Massey University, Albany, New Zealand
(Massey University, 2017) Baker, Maria
The status of Māori mental health in New Zealand has increasingly deteriorated, despite radical changes to mental health service delivery and modern improvements in treatment. The question posed in this doctoral research is: What is occurring amongst Māori with mental illness and mental health services? The research applied qualitative methods. Glaserian grounded theory, informed by a Māori centred approach, was utilised and further supported by the concepts of mana Māori (control), whakapiki tangata (enablement), whakatuia (integration), and Māori ethical principles. Thirty Māori participants between the ages of 20 and 65 years were interviewed; 24 were interviewed individually and the remaining participated in a focus group of six Māori women. Participants identified as Māori with lived experience of mental illness and mental health services. The cohort also included whānau members and Māori practitioners who were interviewed during the process of theoretical sampling. Thirty interviews were audio recorded and field notes were taken. A systematic process of data collection and data analyses occurred using a range of methods as part of the Glaserian grounded theory method. This included coding, memoing, the constant comparison of data and theoretical sampling, all of which helped to reach the saturation of data. The goal was to discover what the main problem was for Māori participating, and how they resolved it. The outcome from this research was the development of a middle range substantive theory titled Seeking Solutions to Being Restricted. The core category, Being Restricted, is recognised as the main problem Māori, in this study, grappled with in regard to their mental health and wellbeing. This includes subcategories with a number of properties: the turning point, being apprehended, physical compromise for mental stability and addressing wairua. The basic social psychological process, Seeking Solutions, was influenced by Māori aspirations for hope and change. This process explains various behaviours where Māori are fighting for their goals and desires to be met or they are having to adapt to a mental health system in order to acquire their goals. Together, the core category and the basic social psychological process represent the theoretical proposition that Māori with experience of mental illness and mental health services are Seeking Solutions to Being Restricted. From the findings of this study, recommendations are provided to address Māori being restricted. The implication of this study is that if mental health professionals and mental health services continue to contribute to an oppressive approach to Māori, there will be an increasing disadvantage to the mental health of Māori.
Understanding matakite : a Kaupapa Māori study on the impact of matakite/intuitive experiences on wellbeing : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Studies at Massey University, Papa-i-ōea, Aotearoa
(Massey University, 2014) Ngata, Ronald Spencer
This thesis is a response to expressions of concern from within Māori communities and also from within mental health that some Māori who are diagnosed as mentally ill are actually having spiritual experiences, which in the Māori culture are called matakite (among other terms). The thesis explores this issue from a Kaupapa Māori perspective, which enables a multi-layered, culturally resonant, exploration and analysis of the health issues that arise in relation to matakite. Thus, while exploring the nature of the experience, the thesis also explores the impact of social, cultural, political, and economic factors upon the wellbeing of people experiencing matakite, and which have hindered the use of the Māori spiritual knowledge-base as a health resource. It is expected that this thesis will increase understanding of the nature of the experience and its relevance within contemporary Māori society, and therefore contribute to the reduction, and ideally elimination, of the misdiagnosis of matakite as symptomatic of a mental disorder. An exploration of the literature reveals a history of ignoring or misunderstanding experiences of a spiritual nature by mainstream Western mental health researchers, clinicians, and policy makers. However, new interest in this field is emerging, and attention has been turned to the development of bio-psycho-socio-spiritual models. Nevertheless, Western biomedical frameworks continue to dominate the discourse and practice in mental health, despite decades of calling for a more integrated approach from many health disciplines, researchers, indigenous communities, and mental health consumers. viii The study reveals new understandings about the nature of matakite experiences, which may support efforts to distinguish between matakite and pathology. Multiple factors are identified as impacting upon the wellbeing and health of people experiencing matakite. The impact of social and cultural factors, as well as the politics of mental health, upon the wellbeing of matakite are identified, and possible strategies for enhancing and protecting wellbeing around matakite experiences are discussed. To this end the study challenges the norms and structures in mainstream Western mental health and highlights how traditional Māori knowledge about matakite can be used as a resource for mental health in Aotearoa New Zealand.
Ko au te wahine Māori : a phenomenological study of Māori women diagnosed with a mental illness and their experiences of pregnancy and childbirth : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Social Work, Massey University
(Massey University, 2006) Semmons, Wendy Violet
To date there have been no specific studies undertaken about Maori women, diagnosed with a mental illness and their experiences of pregnancy and childbirth, and the services they accessed during this period. I look at the history of psychiatry and psychology and compare that with what it means for Maori to be well, and the differences in treatment approaches between the two. The research involved a review of the literature relative to the study. However, given the paucity of research written about this topic, a wide range of literature was used to form the backdrop to the study. Using a phenomenological approach following Colaizzi's method, seven Maori women diagnosed with a mental illness as described by the Diagnostic and Statistical Manual, fourth edition (DSM-IV) were interviewed and their narratives analysed. The four criteria for inclusion in the study were that the women: I. identify as being Maori; II. have experienced pregnancy, and childbirth; III. had a diagnosis of mental illness, and considered stable enough to take part in the proposed study, as assessed by the Maternal Mental Health staff involved and; IV. there was no documented neurological illness, brain damage, or mental retardation, Three major themes emerged which formed the basis for the analysis. Specifically, identity as a Maori, the treatment approaches participants encountered, and how and why tikanga Maori should be integrated into service delivery for Maori. The results of the study indicate that the participants felt there was a lack of co-ordinated care between services, and that much needs to be done in order to provide appropriate health and mental health treatments for Maori. This includes further research and ongoing workforce development.
"Hua oranga" : best health outcomes for Māori : a thesis presented for the degree of Doctor of Philosophy in Māori Studies at Massey University, Wellington, New Zealand
(Massey University, 2002) Kingi, Te Kani R
Poor mental health is recognised as a major threat to Māori well-being. Over the past three decades Māori admissions to psychiatric facilities have increased dramatically and have coincided with increasing socio-economic disadvantage - gaps which exist between Māori and non-Māori, as well as progressive alienation from te ao Māori (the Māori world). Hua Oranga (translated literally as the fruits of health) is both the title of this thesis and the name given to the tool which it describes. The tool is a measure of Māori mental, health outcome and is based on Māori perspectives of health, Māori philosophies, aspirations, and world views. It is a tool designed for clinical and care settings, and measures the efficacy of treatment, or health interventions. The tool employs a triangulated method of outcome assessment and considers the views of tangata whaiora (Māori mental health consumers), clinicians, and whānau (family members). A series of five clinical-endpoints have been identified to allow the tool to be applied with greater precision. By itself the tool will not address all of the complex problems associated with Māori mental health - nor is it designed to do so, indeed that is well beyond the brief of this investigation. What it does however, is to illustrate the utility of seeking outcomes of cultural significance, the employment of Māori perspectives to shape outcome measurement, and the implications for treatment and care. At a broader level, the tool has the potential to contribute to the development of more effective strategies, policies, and service design. To this end, Hua Oranga will contribute to improved health outcomes for Māori.

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