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    Mental health conceptualisations and perspectives on mental health services of Black Sub-Saharan African migrants and refugees in Aotearoa New Zealand : a doctoral thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatu Campus, New Zealand
    (Massey University, 2025-08-22) Musakwa, Michelle
    The number of African migrants and refugees is increasing in Aotearoa-New Zealand (A-NZ). However, there is still limited understanding regarding the mental health experiences of Black Sub-Saharan Africans. Without adequate knowledge of the experiences of this population, it is difficult for mental health professionals to provide culturally appropriate services. As such, it is prudent to develop an understanding of the way this population conceptualises, experiences, and manages mental health and mental distress. This study explores how Black Sub-Saharan Africans in A-NZ conceptualise and manage mental health and their perspectives on mental health services in A-NZ. A qualitative approach was employed, with data collected through nine semi-structured individual interviews and two focus groups (each with four Black Sub-Saharan African women). Individual interview data were analysed using Interpretative Phenomenological Analysis, highlighting the role of identity in mental health conceptualisation and the intergenerational and gender differences that exist. Focus group data were analysed through Reflexive Thematic Analysis and key themes identified included barriers to accessing services and participants’ preferences regarding mental health services. Overall, this study found that culture and identity play a critical role in how Black Sub-Saharan Africans perceive mental health. These factors also influence people's experiences with mental health services. Understanding the cultural nuances of Black Sub-Saharans in A-NZ can help mental health clinicians develop an ethos of engagement that promotes better quality of care.
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    Loto Malie (Contented Heart) : understanding Pacific youth mental wellbeing : a thesis by publication presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2024) Auva'a-Alatimu, Taulaga Monica
    The voices and perspectives of Pacific young people can often be overlooked, yet they are instrumental in shaping the future of today’s society; their voices need to be amplified. Pacific youth, a diverse and vibrant group in Aotearoa New Zealand, are facing growing mental health concerns and are less likely than youth of other ethnicities to seek psychological help due to stigma and a lack of mental health awareness. The paucity of culturally appropriate psychological interventions may contribute to Pacific youth’s reluctance to seek help. The Ministry of Health has encouraged the implementation of Pacific worldviews when promoting the wellbeing of Pacific youth. This study aimed to contribute to the development of new knowledge in Pacific Mental health research and psychological interventions for Pacific youth. To date, there has been limited published research on psychological approaches which integrate spirituality, culture and a digital intervention for promoting mental wellbeing in Pacific youth. This research explores Pacific youth’s experiences of engaging with mental health tools, specifically a Pacific mental health intervention developed for the very purpose of meeting the needs of Pacific youth, Loto Malie (contented heart). In exploring youth experiences and perspectives on mental health, prioritising Pacific-Indigenous knowledge in the research methodology was fundamental. Consequently, the Fa’afaletui and Talanoa frameworks, which draw on Pacific-Indigenous methodologies, provided culturally sound processes for engagement with Pacific youth which allowed them to share their stories and experiences authentically. The findings highlight the key themes that formulate and conceptualise the Loto Malie therapeutic framework, revealing the importance of interweaving culture and spirituality within the therapeutic environment, especially as this strengthened Pacific youth engagement with this approach. At the outset, the aim of this PhD was to explore digital mental health tools with youth, given the low uptake of such tools specifically among Pacific youth. The primary researcher developed an innovative cultural digital mental health intervention, Loto Malie 2.0 Mukbang + mental health, as an interim measure during the pandemic. This innovative approach was shared privately (upon invitation) via YouTube and Facebook. Loto Malie 2.0 aimed to provide accessible cultural and clinical examples that promoted mental health awareness and meaningful connections with the viewers, who were predominantly young adults. Overall, developing the Loto Malie programme and Loto Malie 2.0 allowed young people to attain mental health knowledge and equipped them with relevant tools for wellbeing improvement. Therefore, this newfound knowledge and wisdom provided initial evidence that Pacific youth engage effectively with mental health tools when they are grounded in a Pacific therapeutic approach embedded within their worldviews. The Loto Malie therapeutic framework aims to serve as a guide for Pacific therapeutic approaches to enhance the overall wellbeing of Pacific youth.
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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.
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    Service user views of clinical psychologist competence : a thesis submitted in partial fulfilment of requirements for the degree of Doctor of Clinical Psychology at Massey University, Albany, Aotearoa New Zealand
    (Massey University, 2023) Stevenson, Alice
    People who engage with mental health services are often not included when developing professional practice guidelines, including clinical psychology core competencies. There is a lack of research regarding how service users view psychologist competence, and service users have never been explicitly involved in generating related competencies. This leads to a limited understanding of whether existing conceptualisations of competence and competencies align with service user views. I aimed to inform current theoretical and practical understandings of competence and competencies by asking what service users identify as competent practice for clinical psychologists (CPs) and how service user views of clinical psychology (CP) competence aligned or contrasted with existing aspects of the New Zealand Psychologist’s Board (NZPB) core competencies. I adopted a social constructionist, user-led orientation based on co-production principles. This informed a mixed methods survey (n = 73) and individual interviews (n = 12) that asked A-NZ adults who had seen CPs for mental health support how they viewed CP competence. Analyses included descriptive statistics for quantitative data, content analysis for the qualitative survey data, and thematic analysis for the qualitative interview data. The analyses were then compared with the existing core competencies. The findings included five main areas that participants highlighted as important for CP competence: Interpersonal Skills and Relational Presence; Responsive Contact; Cultural Responsivity; Mental Health-Related Stigma, Discrimination, Exclusion, and Power (MHSDEP); and Safe Processes and Profession. A major aspect of service user views that contrasted with the NZPB competencies was the area of MHSDEP, especially in reference to power. Service user views of competence inform contemporary conceptualisations of competence and provide information about what is needed to make the current competencies more responsive and fit for purpose. I recommend that service user views be incorporated into the current competencies. It is clear from this study that the views of people with lived experience of mental distress are crucial for informing professional practice processes and guidelines for psychologists and mental health services more widely.
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    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.
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    'That fantasy that you can deal with everything yourself and move mountains', an examination of men's beliefs and media representations about mental health services : 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, 2021) Gallagher, Jake Marek
    Young men tend to be less likely to seek help for mental distress due to barriers to help-seeking. Lack of knowledge and negative attitudes regarding services is one such barrier to help-seeking; however, little research examines what men who have not accessed services believe services involve. Likewise, there is little research assessing how services are presented in news media. This project comprised two studies designed to address these gaps in the literature. Both studies utilised inductive thematic analysis within a social constructionist epistemology to examine possible influences on men’s help-seeking. Study One aimed to develop an understanding of young men’s beliefs about mental health treatment when they have not utilised such services. Ten young men who had not accessed services participated in a semi-structured one-on-one interview. Participants expressed a preference to fix problems independently if possible, negative views of the possibility of relying on prescription medication, and they likened talk-therapy to informal social supports. They also acknowledged the limits of their understanding of services, stating that most of their beliefs were based on fictional depictions of services, and that in a consultation they would likely listen to their doctor’s advice. It was concluded that better public education regarding services and treatment may affect attitudes and behaviours towards services; however, the culturally embedded imperative to deal with problems independently also requires challenging. Study Two aimed to understand how services were presented in digital news media. A preliminary quantitative content analysis identified recent rates of mental health reporting on the news platforms Stuff and NZ Herald. Articles were taken from May and February 2019, the most recent peak and trough, respectively, of mental health related articles. Thematic analysis of these articles indicated that news media presented positive outcomes of mental illness through recovery. However, articles also stated that services were underfunded, and understaffed, that mental illness is a rising issue in New Zealand, and that government was not doing enough to improve services. Thus, although the news media gave the message that recovery is possible, it also framed services as struggling, which may have implications for intentions to help-seek.
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    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.
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    Treatment barriers for Māori with social anxiety : a Māori perspective : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University -- Te Kunenga ki Pūrehuroa, Albany, Aotearoa New Zealand
    (Massey University, 2018) Armstrong-Barrington, Pixie
    Social anxiety is a common and debilitating mental health difficulty, however many individuals who suffer from it do not seek help. Research has found social anxiety to be prevalent among Māori and overall treatment rates disproportionately lower. This suggests that a large proportion of Māori with social anxiety in New Zealand are not seeking treatment, highlighting the need for research that explores a Māori perspective of social anxiety and its treatment barriers. In New Zealand there is limited literature pertaining to Māori experiences of treatment-seeking for social anxiety. Utilising a Māori-centred framework, this study aimed to address this through qualitative methods to describe how adult Māori with social anxiety understand their symptoms, treatment barriers, and how treatment barriers could be reduced. The study had the objective of giving validation to the unique perspective of Māori with social anxiety and contributing to the development of culturally appropriate mental health services in New Zealand. Eleven semi-structured interviews were carried out with adult Māori clients who had experienced social anxiety. A brief purpose-built questionnaire exploring six treatment barriers related to social anxiety identified in the literature was also utilised during the interviews. Participants’ interview responses were analysed through thematic analysis to identify themes from the descriptions of their lived experience. Themes highlighted social anxiety as understood as complex and influenced by a number of factors. The questionnaire data supported the thematic analysis findings and together showed treatment barriers as relating to unrecognised social anxiety, social attitudes, psychological symptoms, and cultural disconnection. An increased awareness of social anxiety and its treatment barriers will likely benefit Māori clients and their whānau in managing social anxiety and accessing treatment. The implementation of group programmes and additional information in the community will likely help to increase this awareness and help-seeking behaviours. The research makes a small but unique contribution to literature and clinical practice pertaining to Māori with social anxiety.
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    Primary teachers' knowledge, beliefs and perspectives on the practice of mindfulness in schools : a thesis presented in partial fulfilment of the requirements for the degree of Master of Educational Psychology in Education at Massey University, Manawatū, New Zealand
    (Massey University, 2018) Kenwright, Debbie
    Youth mental health and wellbeing is a complex issue which requires prevention strategies from early childhood through entry into adulthood. Schools are well positioned to promote and develop student’s overall capacity for wellbeing and have a responsibility to do so. Mindfulness has been identified as a potential practice to support the development of wellbeing and human flourishing in both clinical and non-clinical settings. There is an increasing body of research which has found mindfulness-based interventions to have positive effects on human wellbeing and academic achievement as well. Mindfulness practice also develops an attitude of acceptance which fosters equanimity, creating space for reflection and perspective taking; allowing for self-acceptance and greater awareness of self and others. Increasingly mindfulness skills and capabilities are being fostered through mindful-based programs designed for school curriculums. The aim of this study was to gain a greater understanding of primary teachers’ knowledge, beliefs and perspectives about mindfulness in schools. Specifically, this study aimed to capture primary teachers’ views who have not yet been involved in the training or implementation of a formal mindfulness school based program. Placed within a constructivist epistemology this study included 45 participants (n=45) who completed an online survey. The survey was designed using mixed-method research methodology to gather teacher perspectives. Results revealed most primary teachers in this study were prepared to implement mindfulness in schools, and believed schools should be providing mindfulness programs. The results of this study indicate that the implementation of mindfulness in schools is both supported by teachers and viewed as feasible to implement in primary settings. Teachers understood some of the ways in which mindfulness promotes and develops valuable life skills for students in relation to improving their mental health, building individual capacity for coping, and being resilient, and improving student’s overall well-being. Implications for schools and teachers interested in beginning a mindfulness programme at primary school are discussed.
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    Healing from the horror of war : a study of a post-conflict psychosocial program for refugees in Uganda : a research report presented in partial fulfilment of the requirements for the degree of Master of International Development at Massey University, Palmerston North, New Zealand
    (Massey University, 2018) Manson, Tim
    Uganda, a landlocked African nation of 41 million people, currently hosts 1.1 million refugees from surrounding nations including South Sudan, the Democratic Republic of the Congo (DRC) and Rwanda. Many of these refugees have suffered significant psychological trauma as a result of their conflict experiences and through the process of fleeing from their homes and communities. Tutapona is a non-profit organisation that provides group based psychosocial trauma rehabilitation support among war affected populations. This research report examines the effectiveness of the ‘Grow’ program at empowering refugees. The study was carried out in Rwamwanja Refugee Settlement in Western Uganda, which is home to 64,000 people from the DRC. Four refugees who had attended Tutapona’s Grow program were interviewed in depth about their experience and subsequent decisions to ascertain the extent to which empowerment had taken place. The research report concludes that Tutapona’s Grow program has achieved a high degree of success at empowering refugees, especially on the individual and relational levels. More broadly, it suggests that psychosocial interventions in post- conflict settings should be more highly prioritized by humanitarian and development actors.