"Taking Back Control' - Co-existing Disorders Symposium

When I got the email from Tepora Merito-Apirana inviting me to this symposium there were a number of statements that sealed the deal.

Firstly there was the chance to be with what Tepora described as twelve wonderful people from Whakatane, Rotorua, Te Puke and Ruatoki. 

Then there was the commitment given that this symposium would be focused on delivering subjects that are beneficial and empowering for your whanau. 

And finally, it was the focus on ‘taking back control' and that was it - the tickets were booked and I was on the next plane!

There is no more appropriate place to be debating the path to self-determination than inside Rongokarae; the ancestral house of the Ngāti Rongo people of Ngai Tūhoe.  

For the history of Te Urewera is one which is intricately and profoundly linked to the pursuit of mana motuhake. 

The unique precedent established with the Urewera District Reserve Act of 1896, in establishing what historian Judith Binney describes as the only "legally recognised, self-governing tribal enclave in the country" can't help but influence the spirit and the character of all who live in this rohe.

And so I am very pleased, to come here today, to consider where Whanau Ora fits in the context of the study you have been doing in pursuit of the Diploma in Maori Health - Co-existing Disorders.

The pathway to taking back control for whanau will be the key feature of this symposium; a symposium which is targeting whanau, hapu, iwi  and practitioners working in the Mental Health and Addictions Sector.

All of us in this whare appreciate the intensity of the context surrounding this mahi - the over-representation of Māori with mental health and addictions problems; the prevalence, severity and burden of mental illness, and a greater lifetime risk for Maori of developing a mental illness.

We know also that whanau members with co-existing problems often fall between the cracks of services - torn between addiction and mental health services; high rates of relapse frequently affecting the levels of engagement.

We also understand the adverse effect this has upon all our whanau and hapu - I am sure that if I was to go around the room we would all have stories to share of whanau members who may be alcohol dependent and have depression as well, or are beset by an addiction to pathological gambling as well as attacks of anxiety.

In some settings this might be described as having a diagnosable condition; a co-existing disorder; co-morbidity, concurrent disorder or even dual diagnosis.

But for all of us here today, under the umbrella of Te Pu Wananga o Anamata, we have a different way of talking - a way which is shaped by the worldviews of Tuhoetanga.

And I want to firstly congratulate Te Pū Wānanga o Anamata for your unique reputation, in being the only education provider to offer a co-existing disorders qualification that has an emphasis on Māori philosophy to cater to Māori clients and communities.

I have to say I have always had a problem with focusing on excessive labeling of the experiences tangata whaiora face with terminology such as co-existing disorders or diagnosable conditions.

I always think a deficit focus brings deficit results - if we look for problems we can tend to overlook the solutions.

And so I was thrilled when I looked at your programme to see topics such as celebrating whanau success - hautu ko te ora; whanau-principled leadership; What culturally diverse practitioners need to know when working with whaiora; lead the way or be led away.

Already those titles are inspiring - bringing with them a focus of enabling whanau to focus on their strengths; to empower themselves to determine their own solutions.

And so I want to formally recognise the talents and skills that are already evident in the graduants of the 2010 Diploma in Applied Māori Health Coexisting Disorders:

• - Tepora Apirana
• - Cerena Tahu
• - Daile Peni-LeVaillant
• - Mary Ohlson
• - Materoa Peni
• - Isobel Whelan
• - Huka Williams
• - Rachel Haumate
• - Jean Mansner
• - Jacqueline Thompson
• - Tau Thompson
• - Ray Wihapi

You have a big challenge ahead of you, to place your newly acquired practice skills and knowledge, alongside the wisdom of the worldviews inherited from Te Ao Maori.

This is where Anamata really comes into its own - promoting and advancing Māori models of healthcare alongside other models of healthcare, management and delivery in the addictions field; while all the time working with whānau impacted by co-existing problems.

It is in placing whanau at the centre of your approach that I believe you have achieved the distinctive edge - the difference that leads to positive outcomes for our whanau.

I am sometimes concerned that one of the downstream effects of the by-Maori-for-Maori philosophy has been that alongside of taha wairua, taha tinana and taha hinengaro is a new category - taha service provider.

As you will know the whare tapa wha model promotes taha whanau as an essential foundation of our health.   We have to be vigilant about promoting the vital role whanau play in the health and wellbeing of whanau, hapu and iwi.

We might ask ourselves the question - are we teaching whanau to fish for themselves?

Or are we providing them with the fish, but forgetting to work with them, to enable them to do for themselves?

And so I hope that throughout this symposium these questions might run through your heads....

• Ø where and how are we engaging with whanau?
• Ø How are we enabling whanau to have trust in themselves?
• Ø What are we doing to support whanau to place faith within their own diagnosis as the first port of call?

And I want us to be very clear - that every whānau that accesses health and social services does so because they have taken the huge step forward of acknowledging they want and need help.

The greatest expectation I have for Whanau Ora is that we will change the attitude of providers, of the state, and of whanau themselves, to be one in which we appreciate that the whānau knows best what their needs are and what services - if any - they want.

We are at a very exciting phase of rolling Whanau Ora out.   On Friday, I announced the selection of 25 Whānau Ora provider collectives representing some 158 providers who have been chosen to advance their own Programmes of Action.

In this rohe, you will no doubt be aware of the success of Te Ao Hou Whanau Ora network - comprising Whakatohea, Ngai Tai, Te Whanau-A-Apanui, and the wider rural Eastern Bay of Plenty.

I am rapt that there is so much enthusiasm for an approach which places priority on collaboration and cooperation with other providers; the network tied together by an integrated contract with one reporting outcome.

I think this approach is particularly relevant for our whanau who are experiencing issues impacting on their own resilience and capability, while also confronting the challenge of issues such as alcohol and drug abuse, problem gambling, or cyber addiction.

What we need most is not a multiplicity of people knocking on our whanau doors; but people with a multiplicity of skills who can respond effectively and appropriately to a multiplicity of issues.

And ultimately, we know it is whanau themselves, who are the best ones to understand the impact of coexisting problems; and who should therefore lead the development of whanau plans - alongside of a whanau navigator who can assist them to achieve the changes they aspire for themselves.

It is my belief that the most effective outcomes will come from whanau themselves, and will be ones which integrate both cultural and clinical elements in the care.

Te Ariari o te Oranga: The Assessment and management of people with coexisting mental health and substance use problems describes the integration of cultural and clinical elements to care as being ‘cultural competency'.  

But they also place a challenge - that it is not enough to have cultural competence - we should also be working to ensure tangata whaiora and their whanau understand the korero and are able to make informed decisions to act on the korero.  They describe this as cultural fluency.

Whatever terms we use, the application of our taonga tuku iho is fundamental to recovery.   It is great to see some space on your programme for the Mauri Ora framework which I have always really loved for the inspiration it provides to whanau from our own practices and values.

Finally, I want to just acknowledge the importance of Matua Raki - the Addiction Workforce Programme - and the efforts that they are taking to improve addiction services and mental health services capability to work with people who have coexisting problems. 

Anamata can be really proud of the contribution you are making to Matua Raki - and also to the health and wellbeing of our nation - through the achievements of the twelve graduants we honour today.

I commend everyone involved in this prestigious pathway which is both competency based and whānau centred, it recognises and is built from the skills, experience and knowledge needed when working with whānau, while all the time being shaped within our tikanga and kaupapa.

And most of all, I congratulate our graduants and I wish you all the greatest courage to go out and make the difference that all of our whanau are calling for.