The RCPsych Article of the Month for May is ‘A partnership between Māori healing and psychiatry in Aotearoa New Zealand‘ and the blog is written by authors Wiremu NiaNia and Allister Bush and the article is published in BJPsych International.

^{Photograph © Kausthub Desikachar}

Wiremu NiaNia

From my Māori world view, wairua or spirituality is our essence. Everything else flows out from there. If we don’t get spiritual wellbeing right, other approaches will have only limited benefit. It seems to me that psychiatry offers treatments that are focused on the brain, addressing physical and psychological wellbeing. I notice that western talking therapies often don’t address spiritual values that are of critical importance to Māori and other Indigenous peoples.

These days I work as a tohunga, a Māori healer, at a Māori health provider in Aotearoa (New Zealand). When Allister and I first met and worked together in 2005, we were both working at Te Whare Marie, a dedicated Māori mental health service.  Most of the clinicians were Māori. At our service there were clinicians skilled in using Māori therapies. However, in mainstream mental health services, Māori healing wasn’t openly acknowledged. People didn’t know much about it, due to the history of colonial suppression of Māori healing methods.

In my younger years, I preferred radical protest action to address the injustices that we were facing such as loss of Māori land, language and identity. More recently, I have been interested in other methods to effect change. Āhuru māwake refers to a gentle southerly breeze. When its blowing, people don’t resist it. If it starts to become a squall, people may put barriers up. These days I’m interested in dialogue.

My working partnership with Allister is an example of that style. Our article, which the Royal College of Psychiatrists have chosen as their ‘Article of the month’ for May 2023, describes how we work together. I hope you enjoy it.

Allister Bush

I first met Wiremu at Te Whare Marie shortly after we both began working there. I had just qualified as a child and adolescent psychiatrist and was taking my new consultant role very seriously. Wiremu who was employed as a cultural therapist, was friendly, mischievous, and encouraging in his manner. He persuaded me that I could learn the guitar by teaching me basic chords. He taught me karakia (prayers or incantations) that I could use in my hui (meetings) with Māori families and young people. However, he had little to say in multi-disciplinary team meetings and I had no clues about his style of practice. One day a nurse on our team returned from a home visit with Wiremu to see a family. This whānau (family) had been very mistrustful of our service. Following that single meeting with Wiremu their reticence evaporated.  I was curious to know what he had done that contributed to that turn around. When I asked Wiremu he shrugged and played it down. Even more curious, I asked him if he would allow me to sit in on a consultation with him, to which he agreed.

Our article highlights concepts and principles that create a foundation for Māori healing and psychiatry to work together. It offers a case outline relating to a young person and their family that we saw together, illustrating this partnership in action. In the intervening years, we have spent many hours talking together about our different understandings and developing methods for collaborative practice.  I have learnt that Māori families often appreciate having access to both Māori healing and psychiatry perspectives alongside each other.

The burgeoning prevalence of mental health symptoms among both children and adults around the world in recent years, exacerbated by the Covid crisis, is a grave concern because of the consequent pressure on services. Western medicine has made great advances in the management of major mental illness, but there has been relatively little progress in the evolution of novel therapies for less severe conditions. The situation is much worse in many, if not most, low- and middle-income countries (LMIC), where the magnitude of the burden on skeletal mental health services far outstrips supply of Western-trained expertise. Accordingly, in LMIC many people turn to traditional healers for support and guidance. How these healers conceptualise mental health disorders, and how they go about managing them, is a subject we would like to explore further over the coming months and years. We are keen to learn more about their work and how it might be integrated with ‘conventional’ (Western) approaches. Our article of the month provides a case study of such a partnership among the Māori peoples of New Zealand, and the successful treatment of a young man with pseudo seizures.

David Skuse

Editor-in-Chief, BJPsych International