First National Maori Child, Adolescent and Family Services Hui

Te Whare Marie, Porirua Hospital, Porirua (20 th and 21 st July 1999)

Summary Report by Vickie Amor

Sponsored by the Mental Health Commission P O Box 12 479 Whanganui-a-Tara, Aotearoa

Tel 04 474 8900, fax 04 474 8901 email [email protected]

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

CONTENTS Executive Summary 4

Background to the Hui 5 Kaupapa o Te Whare Marie 5

Hui Speakers 6 Bob Henare (Mental Health Commissioner) 6 Elizabeth Cunningham (National Manager Maori Mental Health - Health Funding Authority) 6 Dr Tony Ruakere (Chief Advisor Maori Health - Ministry of Health) 6 Arawhetu Peretini (Senior Advisor Maori - Ministry of Health) 7 Te Kani Kingi (Maori Mental Health Researcher) 7 Dr Peter McGeorge (Mental Health Services Manager, Capital Coast Health) 7

Action Points 8 Reference Group 8 Working Party to Develop Cultural Assessment Tool 8 Strategies for Service Delivery and Workforce Issues 8 Next Maori CAFS Hui - Conference Planning Team for Auckland 2000 8 Updated Maori CAFS database 8

Evaluation of the Hui 9

Appendix 1 - Workshops 10 Workshop One – Elements of a comprehensive Maori CAFS service summary notes 10 Workshop Two – Cultural Assessments summary notes 12

Appendix 2– Maori CAFS Workers Contact List 14

Appendix 3 - Working with Maori Rangatahi, Tamariki and their Whanau 19

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Executive Summary

The first National Maori Child, Adolescent and Family Services Hui was held at Te Whare Marie, Porirua Hospital on 20 th and 21 st July 1999. The Mental Health Commission, in recognition that Maori CAFS workers needed to meet and discuss various concerns, sponsored this hui.

The hui gave Maori CAFS workers the opportunity to network, identify training needs, exchange information and resources, discuss current issues, look at how workers can continue to network and develop a cultural assessment tool/process.

There was a positive response to the hui, with about 70 people attending. There was good kaumatua representation and teams were represented from as far away as Whangarei and Invercargill.

The programme, developed in consultation with participants, consisted of powhiri, mihimihi, hakari and poroporoaki, two workshops, an open forum and six speakers.

The speakers were: Elizabeth Cunningham (Health Funding Authority) Arawhetu Peretini (Ministry of Health) Dr Tony Ruakere (Ministry of Health) Te Kani Kingi (Maori Studies, Massey University) Bob Henare (Mental Health Commission) Dr Peter McGeorge (Capital Coast Health).

Valuable connections and links were established amongst Maori CAFS workers and speakers. In their evaluation of the hui participants acknowledged the inspirational contribution by speakers, along with the excellent venue, catering and hospitality.

Te Whare Marie staff and the caterers are to be commended for their hard work and contribution towards the success of the hui.

At the hui, participants began work on the following agreed actions: 1. to form a reference group to look at representing all Maori CAFS workers at inter-agency mental health meetings; 2. to establish a working party to look at developing a cultural assessment tool; 3. to investigate strategies to improve service delivery and workforce development; 4. to hold an annual Maori CAFS hui (planning for the second national hui is currently underway); and 5. to prepare an updated Maori CAFS list to encourage networking.

It was agreed that discussion amongst the reference group, the working party and across the mental health sector must continue to follow through on the above actions.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Background to the Hui

At a meeting held in Christchurch in November 1998 during the “ Today’s Tomorrow – the Mental Health of our Tamariki and Rangatahi ” conference, Maori CAFS workers identified their isolation and their need to meet and korero about their concerns and directions for the future.

The Mental Health Commission agreed to sponsor the first National Maori Child, Adolescent and Family Services hui and engaged Vickie Amor (Maori CAFS social worker, Wellington) to organise the hui and bring together speakers and participants.

The hui was organised to coincide with the Ministry of Health’s national child and youth sector meeting in Wellington on 22 July 1999.

Kaupapa o Te Whare Marie Ani Sweet spoke about the beginnings of Te Whare Marie. Her summarised comments were as follows:

In 1984 Hui Whakaoranga was held. It provided an opportunity to further develop mental health provision for Maori. Upon returning to Wellington the Maori staff created a forum that began informally. The Maori forum grew in strength and lobbied for the consolidation of what was to become Te Whare Marie in 1990 which officially opened in 199 and has continued to grow.

The whare provided was a condemned old orthopaedic ward. No resources were provided to establish or refurbish the whare. Kaimahi provided the work they were able to.

Materoa Mar acknowledged the work of Te Whare Marie and that it had continued to grow in strength. She stated that Te Whare Marie has continued its growth as a service provider in the Kapiti to Wellington area. Materoa outlined Te Whare Marie service as consisting of three components: Adult, CAFS and the Day Programme. She also noted that Te Whare Marie encompasses a number of different disciplines.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Hui Speakers Below are summaries of the speakers’ presentations.

Bob Henare (Mental Health Commissioner) Mr Henare welcomed manuhiri and noted that the hui was the first ever to specifically address the issues of Maori children, adolescents and their families.

Mr Henare said the Government has made children and youth a priority, but it is clear, however, that Maori tamariki and rangatahi will require a unique approach. He highlighted the poor statistics of Maori health and the ongoing problems faced by Maori exacerbated by low socio-economic status.

Mr Henare acknowledged the hui as a special and unique group and hoped that it would give Maori CAFS workers an opportunity to network, to identify training needs and current practice issues, and to develop cultural assessment tools and processes for working with tamariki and rangatahi.

Elizabeth Cunningham (National Manager Maori Mental Health - Health Funding Authority)

Ms Cunningham spoke about the respective roles of the Ministry of Health, Mental Health Commission and Health Funding Authority (HFA). She mentioned that the overall HFA budget for mental health is $500million budget with $35 million of this allocated for Maori mental health.

Dr Tony Ruakere (Chief Advisor Maori Health - Ministry of Health)

Dr Ruakere spoke about how he and Trustees representing Te Atiawa have established a general practice. Initially established without contracts, it currently has 500 patients; many are unemployed and cardholders (86 percent). The majority are Maori (90 percent).

Dr Ruakere went on to speak about how he had come to work with the Ministry of Health because he saw health policy as central to ensuring appropriate health services were delivered to Maori. He said that policy was important as it was the basis on which to facilitate change in circumstances for Maori. He stressed the need to push Maori kaupapa in the health funding arena, and noted that possibilities existed to move the goal posts if the players weren’t getting enough ball!

Dr Ruakere also presented a case study of a whanau he had worked with for many years. See appendix 3.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Arawhetu Peretini (Senior Advisor Maori - Ministry of Health)

Arawhetu gave a synopsis of a typical policy development cycle and highlighted the fact that ten years ago there was little mention of Maori health policy but that today it is accepted practice to consider the special needs of Maori. She spoke also about the significant place of Te Tiriti o Waitangi in the policy process and as the acknowledged founding document of this country.

Arawhetu also pointed out that good policy was one which should be able to be used to enable providers, whanau, hapu and iwi to define solutions and to implement those solutions. She also spoke about the importance of ensuring that policies were not designed in a vacuum in Wellington and of the importance for bureaucrats to consult with communities who are the ones who will directly be impacted by those policies. Arawhetu answered questions from the hui and reinforced the need for transparency and accountability in the policy cycle.

Te Kani Kingi (Maori Mental Health Researcher) This presentation examined the development of a Mäori Mental Health Outcome Measure . Whilst designed for routine clinical use the tool considers Mäori concepts of well-being by utilising an existing model of Mäori health – Te Whare Tapa Wha. The tool is consumer focused and also incorporates the perspectives of both the clinician and whanau. This measure is designed to complement existing tools and to offer a viewpoint more aligned to the cultural needs of Tangata Whaiora.

The tool is currently being tested within six locations throughout the North Island.

Dr Peter McGeorge (Mental Health Services Manager, Capital Coast Health)

Dr McGeorge acknowledged Koroua Pikau, Ani and other Kaumatua for their continued contribution to the development of Maori Mental Health Services.

Dr McGeorge said the large geographical area some services cover, such as Northland, and the high demand for service are huge challenges for most services. As well, people working in services are meeting whanau demands from outside the service. He emphasised that Maori are skilled at systems, for example, whanaungatanga and this is a great strength.

He questioned the applicability for Maori of some mainstream clinical/cultural assessments and the need for clinicians to recognise the importance of spirituality and wairua in working with whanau.

He noted the importance of language and the physical environment for service users and whanau.

He talked about ADHD being an issue for Maori, particularly the lack of education for whanau about the condition and the use of medication. He also talked about over- diagnosis of ADHD by practitioners. .

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Action Points

As a result of the first National Maori Child, Adolescent and Family Services hui the following action points were decided.

Reference Group A reference group was formed so Maori CAFS workers could be represented at the inter-agency mental health meetings that began last year. This would also reduce fragmentation and improve communication within the sector. The following people were nominated for the reference group: Materoa Mar, Trisha Bobbette, Paul Love, Ron Baker and Erana Poulsen. It was agreed that Materoa and Paul would attend the next mental health meeting comprising of Te Puni Kokiri, Health Funding Authority, Mental Health Commission, the Health and Disability Commission and Ministry of Health to communicate the action points of the hui.

Working Party to Develop Cultural Assessment Tool After extensive discussion it was recognised that there was a need for a cultural assessment tool. A working party was formed to develop this further and the contact person is Diana Rangihuna, Te Whare Marie.

Strategies for Service Delivery and Workforce Issues Strategies need to be investigated to look at improving service delivery and addressing workforce issues. Information was documented in Workshop One - Elements of a comprehensive Maori CAFS service summary notes. (See appendix 1)

Next Maori CAFS Hui - Conference Planning Team for Auckland 2000

Erana Poulsen (Tamaki Makaurau and Tai Tokerau Planning Team spokesperson) discussed her concerns about being the only Maori presenting at the Christchurch CAFS conference. She felt mokemoke and pulled together Maori CAFS workers at the hui. As a caucus they identified the lack of consultation and need for future hui. This hui at Te Whare Marie is a result of the korero from Christchurch.

There is a need for an annual Maori CAFS hui to address Maori concerns using a united and structured process. Planning has commenced for the second national Maori CAFS hui, which will be run parallel with the International CAFS hui in Auckland from 28 June to 2 July 2000.

Erana requested and was given the mandate for the Tamaki Makaurau and Tai Tokerau Planning Committee to represent Maori CAFS workers for input into the organising committee for the international Auckland 2000 hui.

Updated Maori CAFS database Participants want to receive an updated Maori CAFS list so that they can continue networking and reduce isolation. See Appendix 2 for a comprehensive list of Maori CAFS workers.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Evaluation of the Hui

An Evaluation sheet was circulated and completed by eighteen participants. Feedback indicated that participants found the speakers to be generally very interesting and relevant, the topics covered useful, and the venue and catering were much appreciated.

Organiser’s Evaluation

It was a privilege to be asked to organise the First National Maori CAFS Hui. Participants seemed to appreciate the opportunity to meet and were willing to share their knowledge and expertise in this area.

I was pleased with the running of the hui and appreciated the support from managers/team leaders who enabled their workers to attend, presenters who gave their time willingly, Te Whare Marie staff who were excellent hosts and Mental Health Commission staff who were very supportive.

In future it would be useful to have a time keeper and proper recording equipment in order to capture more accurately the essence of the korero, particularly those in Maori.

Information on the hui needs to be forwarded to the Tamaki Makaurau and Tai Tokerau Committee to assist with the planning of the next hui and to ensure continuity.

Vickie Amor

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Appendix 1 - Workshops

Workshop One – Elements of a comprehensive Maori CAFS service summary notes

Maori CAFS workers

Role - Needs to be a specialist role to prevent it from being manipulated by clinicians. - Need new name to identify Maori who work in mainstream CAFS teams not CAFS workers. - Work with tamariki/rangatahi dependent upon developmental not chronological age. - Invite people to write their own job descriptions. - Lead way with cultural assessments. - Maori CAFS accountable to own people as well as CAFS. - Need to establish ourselves as a discipline. - Set up our own role models/kaupapa to validate our own practices. - Involved in assessments early to work with tamariki/rangatahi separately and as a whanau. - Pay consultancy/wage to kuia/kaumatua in recognition of their contribution.

Training systems - Need cultural supervisors/mentors to support/advise on practice and approaches i.e. kaumatua. - Training at University of Auckland CAMH funded by HFA. - Alien environment – not user friendly and ethnocentric theoretical base. - High workload for those who work full-time results in difficulties training part- time. - Need to be computer literate especially in rural areas to access internet/library facilities. - Lack of Maori supervisors. - Training budget should be set aside. - Emphasis on in-house training/staff train each other i.e. training on different iwitanga. - Tap into kuia/kaumatua who know models and can teach the models to Maori CAFS workers. - Maori training for Maori i.e. Te Ngaru learning systems.

Attracting more staff - Head hunting within CAFS is limited as there are not enough skilled Maori workers to fill vacancies. - To attract more Maori workers we need to go to training institutions i.e. polytechnics, schools of medicine. - Encourage students at polytechnic to do placements in services, look at secondment or bonding. - When advertising for Maori workers we should not emphasis the need for a clinical professional mental health qualification as this may deter those with life experience and people skills from applying. - Bulk advertising of position.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

- Perception of safety important. - A strategic workforce development plan for Maori CAFS essential. - Value nga korero of those who do not have the clinical qualifications. - Emphasise the development of tools from kaupapa Maori base. - Qualification by experience is important but we still need the “ticket”. - Put aside designated money for training Maori. - Shoulder tapping – identify people that may be appropriate for CAFS work. - Interview applicants after 5.00pm.

Cultural/clinical - Moko services work with mainstream services to establish clinical joint ventures and advertise position under a Moko banner. Moko involved in recruitment, planning service, advising services how to spend putea and plan their service – enough Maori clinical mass? - Psychiatrists in CAMH function differently in CAFS services compared to adult. - Maori tikanga lots of practice models/kaupapa i.e. powhiri model. - Important to reinforce models. - Clinician is a teacher in our hapu/iwi who knows how to integrate work liaise/network with iwi, whanau, hapu and tohunga.

Organisation

Better access - CAFS Hutt Valley - mainstream working with iwi to develop the Maori team within. CAFS team, work with iwi to increase Maori within CAFS and develop a kaupapa Maori service. - Services involve youth tangata whaiora in delivery of service to reduce non- attendance and increase participation. - Need to understand youth tangata whaiora needs “their culture”. - Services targeted to youth tangata whaiora. - CAF sounds better than Maori mental health team, name a barrier “mental a barrier”. - Gatekeeping - training intake workers on appropriate referral. - Development referral pathway for Maori – Maori mental health services. - Suggestion that HFA should have a mandate to monitor spending and HHS mainstream Maori full time equivalents.

Utilise limited resources - Utilise limited resources by prioritising. - Management talks to staff – group participation creative accounting.

Systems to nurture and develop - Maori workers need to participate in policy decision-making i.e. encouraged to attend HFA meetings. - Resources items for service targeted money. - Need the infrastructure to influence/advice; be involved in managing service.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Support systems

Support for workers - Supportive/proactive managers/decision makers of services toward kaupapa Maori Service development. - Tangata whenua clinicians need opportunities for whanau/ Maori kotahitanga and whakawhanaungatanga. - Own peer group powerful. - Need to look after and support kuia/kaumatua. - Have own kaumatua/kuia outside mahi so do not over use kuia/kaumatua (those we trust and feel safe with). - Start a whanaungatanga group, get feedback from peers and their service and discuss issues. - Access top dog/look for ally’s tauiwi and Maori to support you and keep sanity. - Liaise and network with Maori services/communities/iwi. - Need supervision to prevent burnout. - Suggestion: Te Whare Marie put in a proposal to HFA Elizabeth Cunningham on how to support kuia/kaumatua working in CAFS. - Need some direction nationally for whai/kaumatua whare/matua on how to deliver/support.

Support for each other - Starship hospital 10 bed residential unit developing a Maori position – concerns re isolation. - We need to keep dialogue/contact open – share ideas including having a list of all Maori CAFS workers. - Put systems in place so that we can find solutions for issues. - Recommendation that this hui be made a national event on an annual basis.

Retention - Maori mental health worker has a low status label; this needs to be changed. - Need to support/awhi tauiwi psychiatrists to work with Maori workers to deliver to tangata whenua. - Important to strengthen our networks. - Maori hui important.

Safe practice - Guidelines to develop safe/consistent service delivery and how kuia/kaumatua can best support CAFS teams.

Workshop Two – Cultural Assessments summary notes

The following is a copy of the notes taken during Workshop two. Powhiri and Poutama Whakapapa Tikanga, karakia Mihimihi Whakatau Preparation phase whakapapa

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Whanaungataunga Kai Kaupapa Maori services and best practices Alignment of service Identity Working within a Maori environment Taha wairua – what’s happening at a wairua level Issues re “cultural assessment” Need to incorporate tohunga into assessment and treatment Maori whakaaro re “assessment” Training

Other aspects of culture included the youth culture. An example given Te Whare Whaiora assessment format can be used anywhere. The identity continuum, living needs, supports available and so forth. Te Whare Tapa Wha – helped to establish sense of identity and core issues.

After extensive discussion there were discrepancies between iwi about who can use cultural assessments, about what happens to the information, etc. Subsequently, a working party was formed to look at developing this work further. The contact person is Diana Rangihuna, Te Whare Marie, Porirua Hospital.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Appendix 2– Maori CAFS Workers Contact List

Last Name First Name Address Phone Number Fax Number Email Address Amor Vickie Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Anderson Dr Jessie Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Arthur Pikau Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Baker Ron Ngati Porou Hauora PO Box 2 Te Puia 06 864 6803 06 864 6831 Biddle Ricky Child & Youth Health South 9 George Street 03 688 1331 03 688 1332 [email protected]. Mental Health Canterbury Timaru nz Service Bobbette Trisha Oranga Hinengaro Totara House PO Box 2056 06 350 8025 06 350 8024 MidCentral Health Palmerston North Palmerston North Hospital Brasted Bob Oranga Hinengaro Totara House PO Box 2056 06 350 8074 MidCentral Health Palmerston North Palmerston North Hospital Budd Claudia Maori Alcohol and Palmerston North PO Box 2056 06 350 9130 Drug Service, Hospital Palmerston North MidCentral Health Cherrington Brenda Te Roopu Kimiora Child & Youth Mental PO Box 742 09 430 4101 09 983 0143 Health Whangarei extn 8315 Cherrington Lisa Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Cruden Fiona Hauora O Te Te 29 Queen Street Waitara 06 75444 4669 06 7544669 Atiawa Dalziel Edwina Youth Mental health 11 Quay Street co-ordinator Whakatane Day Idiana Moko Services 104 Lincoln Road 09 838 9960 [email protected] Waitemata Health Henderson Auckland Dougall Kim Te Oranga Hinengaro Hutt Valley Health 55 Knights Road Lower Hutt 04 566 4596 04 570 1055

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Dutt Vegod The Centre For South Auckland Health Hartford House 09 263 7209 09 263 7218 Youth Health PO Box 23562 Hunters Corner Papatoetoe Auckland Fare Megan Raumano Trust PO Box 57 Patea 06 273 6010 06 2736018 Feast Heather Voyagers Pacific Health PO Box 241 Whakatane Flavell Varina Te Roopu Kimiora Child & Youth Mental PO Box 742 09 430 4101 09 983 0143 Health Whangarei extn 8315 Gage Cran Ngati Porou Hauora PO Box 2 Te Puia 06 864 8803 06 864 8831 extn 815 George Eru CAFS Lakeland Health Private Bag 3023 Rotorua Graham George CAFS Lakeland Health Private Bag 3023 Rotorua Hall Alayne Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Hamlin Colin CAFS 618 High Street Lower Hutt 04 569 8422 Haronga Turoa Oranga Hinengaro Totara House PO Box 2056 06 350 8074 MidCentral Health Palmerston North Palmertson North Hospital Hepi Tangi Maori Alcohol and Palmerston North PO Box 2056 06 350 9130 06 350 8832 Drug Service Hospital Palmerston North MidCentral Health Herbert Averil Department of University of Waikato Hamilton 07 838 4466 Psychology extn 8403 Heremaia Mavis Te Roopu Kimiora Child & Youth Mental PO Box 742 Whangarei 09 430 4101 09 983 0143 Health extn 8320 Hudson Rocky MidCentral Health PO Box 2056 06 350 8210 Palmerston North 06 363 7590 Johns Maraea 11 Quay Street Whakatane Kaa Terina Te Roopu Awhina 196 Warspite Avenue Porirua 04 235 5295 Kaa Marara C/Te Roopu Awhina 196 Warspite Avenue Porirua 04 235 5295 Kawana Raymond MMH CAFS Wairarapa Health Masterton Hospital 06 378 2099 PO Box 96 Extn 5571 Masterton

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Kotlowski Mavis Stop Trust PO Box 13-502 Christchurch 03 374 0710 03 374 9030 Wairerekura Laws Karina CAF Mental Health Healthcare Otago Private Bag 1921 Dunedin 03 474 0999 03 474 7611 Services Extn 5553 Levy Michelle Te Kete Hauora Ministry of Health PO Box 5013 04 496 2440 04 496 2050 133 Molesworth St Wellington Lewis Blondie Youth Specialty Health Care Otago Private Bag 1921 Dunedin 03 474 5601 03 474 5603 Services Love Paul Te Oranga Hinengaro Hutt Valley Health 55 Knights Road Lower Hutt 04 566 4596 04 570 1055 Makowharema Hemi Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 hihi extn 7368 Mar Materoa Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Martin Leonora Hauora O Te Te 29 Queen Street Atiawa Waitara Martin Des Te Whare Rapuora MidCentral Health PO Box 2056 06 350 8210 06 350 8158 Maori Health Unit Palmerston North Mataki Daniel Kaiwhakahaere Stop Trust PO Box 13-502 Christchurch 03 374 0710 03 374 9030 Matenga Michael Oranga Hinengaro Totara House PO Box 2056 MidCentral Health Palmerston North Palmerston North Hospital McClintock Kath Te Puna Hauora Pacific Health Private Bag 07 579 8560 07 579 8565 Kaupapa Maori 12024 Specialist Services Tauranga Mellars James Te Oranga Hinengaro Hutt Valley Health 55 Knights Road Lower Hutt 04 566 4596 04 570 1055 Moorehouse Leisa Child Adolescent Pacific Health 07 579 8560 07 579 8565 Mental Health Service Private Bag 12024 Tauranga Murray Jhan First Episode Te Puna Hauora Pacific Health 07 579 8560 07 579 8565 Psychosis Co- Kaupapa Maori Private Bag 12025 ordinator Specialist Service Tauranga Narayan Luella Te Kete Hauora Ministry of Health PO Box 5013 04 496 2467 04 496 2050 133 Molesworth St Wellington Neate Iwi Te Poutama Arahi PO Box 6090 Upper Rangatahi Riccarton Christchurch

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Ngatai Nan Southern Health 9 Girvan Street Wallacetown 025 201 9873 CAFS Invercargill 03 214 5753 Nicholls Puti Child & Family Unit Starship 16 Parkfield Terrace Grafton 09 307 4949 Auckland Extn 633 Noema Aroha Te Oranga Tonu Healthcare Otago Private Bag 1921 Dunedin 03 474 0999 03 474 7611 Tanga Extn 5553 North Vicky CAF Team PO Box 9014 Hastings 06 878 1643 Paewai Mahalia Oranga Hinengaro Totara House PO Box 2056 MidCentral Health Palmerston North Palmerston North Hospital Papuni Te Uwira Tuia Services Tiaho Mai Private Bag 93311 Otahuhu 09 276 0044 Middlemore Hospital Auckland Extn 2558 Patuwai Dianne Te Korowai Atawhai Sunnyside Hospital Private Bag 4733 03 339 1126 03 339 1127 Youth Specialty Sylvan Street Christchurch Service Peretini Arawhetu Ministry of Health PO Box 5013 04 496 2440 04 496 2050 133 Molesworth St Wellington Pou David Manu Te Roopu Kimiora Child & Youth Mental PO Box 742 09 430 4101 09 983 0143 Health Whangarei extn 8305 Pou McKenzie Child & Youth Mental PO Box 742 09 430 4101 09 983 0143 Health Whangarei extn 8320 Poulsen Erana Moko/Marinoto Woodford House Waitakere Hospital 09 837 6616 [email protected] Services Henderson z Auckland Pukeroa Christine Hauora Waikato Maori Mental Health PO Box 1283 07 839 9916 07 839 9917 Services Hamilton Rangihuna Diana Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Rogers Kore Te Whare Rapuora MidCentral Health PO Box 2056 06 350 8211 06 350 8024 Maori Health Unit Palmerston North Rolleston Mere Hauora Waikato Maori Mental Health PO Box 1283 Hamilton 07 839 9916 07 839 9917 Services Rolleston Bob Hauora Waikato Maori Mental Health PO Box 1283 07 839 9916 Services Hamilton

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Ropiha Awhi Healthcare Hawkes PO Box 9014 06 878 1643 06 878 1639 Bay CAF Team Hastings Extn 5338 Ropitiu Joanne Te Puawai O Te PO Box 9014 Whanau Hastings Scott Janis Youth Specialty CAFS Hutt Valley Private Bag 31097 Lower 04 566 6999 Services Health Hutt Extn 8311 Scrimgeour Julie Anne Oranga Toi Ora Mobile Nelson Marlborough Private Bag 38 03 546 1800 Community Team Health Service Nelson 03 547 2160 Shortland Liana Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Snowdon John PO Box 300791 Lower Hutt 04 570 6023 Sweet Ani Te Whare Marie Capital Coast Health PO Box 50233 Porirua 04 237 4509 04 237 2011 extn 7368 Tua Mavis Child & Family Unit Starship 16 Parkfield Terrace Grafton 09 307 4949 Auckland Extn 633 Tutahi Fay PO Box 30307 Lower Hutt Wahanui Junie Tuia Services Tiaho Mai Private Bag 93311 Otahuhu 09 276 0044 Middlemore Hospital Auckland Extn 2558 Wereta Bernice Te Puawai O Te PO Box 9014 06 8781361 Whanau Hastings Whaanga Jim 814 Oliphant Road Hastings Wharemate David The Centre For Youth South Auckland Health Hartford House 09 263 7209 Health PO Box 23562 Hunters Corner Papatoetoe Auckland Wipango George CAFS Mental Health PO Box 4038 Service Wanganui

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Appendix 3 - Working with Maori Rangatahi, Tamariki and their Whanau

Dr Tony Ruakere Chief Advisor - Maori Health, Ministry of Health

July 1999

Tena koutou katoa Kua Tae Mai Nei I Tenei Ra Ki Te Tautoko Te Kaupapa O Te Ra Nei No Reira, Tena Koutou Katoa

The title of my speech today is:

“Working with Maori Rangatahi, Tamariki and their Whanau”.

Today I will tell you the story of just one family - a family that has experienced tragedy, confusion, anger, dysfunction and yet are still able to share joy and triumph. They have survived. You will see what I mean by survival later.

This family has three children - all boys. The father died several years ago as a result of farm accident, when the children were quite young 5-12 years.

Income was limited, the family moving from farm to farm. He was a hard worker and a hard drinker with an unfortunate history of supplementing family income from things that “fell of the back of a truck” a kind of inside trading. It was a trait that he passed on to his children, especially the middle son. Though responsible most of the time, he was subject to the occasional major event which usually involved alcohol.

He was well known to the police who had called at his home on many occasions - mainly trying to trace lost property. He became frustrated with these calls which he interpreted as being picked on. This frustration, coupled with alcohol, involved the police calling again. This time he had a rifle, was inebriated and aggressive. The police on knocking on the door, were greeted with, “the first blue bottle that steps through the door will get blown away.”

The police withdraw, they know that he will sleep and settle down. Two hours later they enter and take [possession of the rifle, he is sound asleep. He will face charges.

The mother has schizophrenia, first diagnosed at the age of twenty. She is on medication, stable for most of the time. She spends a lot of time watching the soaps, nodding back and forward on a rocking chair. She cooks sometimes, but only when she feels hungry. The children mostly feed themselves, weetbix and cereals.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

She has a wide behaviour spectrum from placid acceptance to bizarre thoughts and behaviour. Her dress is unconventional. She has a fondness for fur - heads turn when people realise that the fur collar she is wearing is alive - yes, a live possum. I warn her that they carry leptosperosis and brucellosis and occasionally TB. No notice is taken.

During one of her admissions the senior nurse takes a group down town for a walk. Patient becomes an embarrassment to the group, dodging from car to car and yelling out, “the police are watching her”. Everyone stares. The nurse for the first time in her career, loses it and takes the rest of the group to the other side of the road. Nurse tells me later that she is quite ashamed of abandoning a patient.

She is a heavy smoker. Following the death of her husband, she has several partners, two of whom are alcoholic. The home environment is unstable and precarious. During an argument over a TV channel, she hits her partner over the head with a full bottle of DB. She is proud of herself.

Her children suffer from Otitis Media, they are rarely brought to the surgery. They all have hearing problems.

Her youngest of age two years is bottle fed - consists of milk and sugar, a couple of teaspoons just tipped in, no fancy supplements here. Child should be on solids by now. We know she is “going off “ when she starts cooking scones, hundreds of them and starts distributing them around town. If she doesn’t like her medication, she just throws it in the river.

One day I do a home visit, the children have been throwing cartridges into the fire, “watch them go bang, Doctor.” There is ash everywhere, this is really bizarre.

Rangi is the eldest son. At the age of sixteen he shows signs of psychosis. He has delusions. His imagination is expansive. He has a fascination with guns and weapons. He is a heavy marijuana user. He soon has a partner and child. He becomes increasingly suspicious of her, accusing her of seeing other men. She finally can’t stand it and leaves. This makes him worse. He has an unhealthy interest in Vietnam war films. He stalks his former partner, breaks a non molestation order and is gaoled. Is he a criminal or a psychiatric patient with dual diagnosis? Is goal the right place for him?

He is released, a brooding, sad man - what is his future? He does not accept that he has a psychiatric disorder and refuses treatment.

The middle son has the most bizarre history of the lot. From an early age 8-9 years, he is in trouble with stealing. He is constantly absent from school, hearing impairment doesn’t help much when he is in school.

Over the next few years he becomes a very proficient burglar and is often before the courts - always in the papers. He is a heavy pot smoker and drinker. There is no discipline at home. His mother never reprimands him. He forges a couple of cheques and mother is so proud that she frames them and hangs them over the fireplace. He

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999 spends most of the next few years on PD or in goal. He doesn’t accept responsibility “It is not my fault.”

Sometimes I think that he is right. The courts call for psychiatric assessment. The doctor finds that he is not suffering from a psychiatric disorder. The doctor ignores the heavy marijuana use. People start to dodge him, he brings shame on the family.

He feels it. He takes on a moko. “Doctor, they will not be able to look on my face like that anymore. I have a new face, a new identity.” He is looking for strength. He seeks guidance.

He is taken on board by a local Maori Prisoner Rehabilitation Group - Te Ihi Tu - Justice Department. Senior staff consist of a former psychiatric nurse and lecturer in Te Reo. Prisoners on parole are taken in. It is a community facility situated at the old hospital.

Here he is taught: a sense of identity, knowledge and understanding of whakapapa self-esteem, confidence and pride personal responsibility respect for others and their property knowledge of te Reo and Tikanga whanau support Te Whare Tapa Wha

There is a tough physical programme, a rough march of two days. He is taken to the springs of Te Maunga O Taranaki where our people have always gone. Over two months the results become promising, even dramatic. Many of the things that he was never exposed to in his childhood now form the basis of his rehabilitation. He now has a partner and two children. He is immersed in the Community with his whanau. He is no longer in the news.

Anaru is the youngest. He make reasonable progress at school but perhaps as a forerunner of what is to come, he is found one day lying on the roadside. He is completely out of it. He is brought to the surgery. The smell gives him away. He is twinked out, yes he has been sniffing Twink!

His life starts promisingly enough and he becomes a mechanic. He does however become involved with a group of people who regularly use marijuana. His work performance starts to suffer, days absent - finally gets the sack.

He presents again at the surgery, eyes glazed and a grin on his face. He is euphoric, on cloud nine. He has been smoking heavily. I remind him again of what pot is doing to him. He has tunnel vision, he no longer cares “Marijuana Doctor, the food of the Gods.”

I am not going to get far with him today. He is happy to stay on the dole and now grows for his own use and, I feel, for exchange - a kind of green dollar scheme he tells me. He has no intention of changing, even appears to be thriving.

Report on First National Maori Child, Adolescent and Family Services Hui, 20 th and 21 st July 1999

Conclusion

I have addressed some of the issues that face young people. I feel some responsibility for them, having delivered them. No, they are not my children.

There is a psychiatric history, drug addiction, violence and rehabilitation. Thank goodness suicide did not feature, though one of the children did suffer from depression. We know that when a parent has a psychiatric history, there is real potential for this being passed on. We are all versed in the dangers of alcohol, marijuana and solvent abuse.

I rang my colleague in Gisborne the other day, Dr Herewini Ngata. They have a pilot scheme going up there. “How is it going?”, I ask. His voice is one of dispair - though promising, he realises how difficult it will be. Similarly with his cousin Dr Paratene Ngata in Tolaga Bay.

I wish now to deal with violence in the home with the previous history of alcohol, guns and exploding cartridges.

Recently Dr Robin Fancourt, Paediatrician and well know national spokesperson on Sexual Abuse wrote on the effects of violence on children. She spoke of the brain damage done to these children who suffered from or witnessed violence.

A grim picture was presented. A child raised in this environment results in a child who has no sense of safety. They never feel safe. The results of continued exposure produces a child who is in a state of constant “red alert”. The developing brain has been damaged, not by physical means but by psychological means.

There is a reaction of fight or flight. Because their survival may have come only from their ability to rapidly interpret danger signals, this becomes permanently imbedded in their minds. The child is now supersensitive to danger signals, for example, the smell of alcohol may trigger a reaction. (if there was a party at the home of the family, one of the boys would start hiding the full bottles in a tree hoping that this would end the party and the fear that went with it).

They live in a war zone and one as mentioned that may become permanent. The major risk is the lack of rapport and attachment to parents and later, to others. It is a malignancy that eats away at the formation of close relationships throughout their lives. It may show for example in ADS. We must intervene at an early stage. The brain must learn new pathways as it develops.

If we don’t intervene, we will leave a legacy of impulse, fearful, aggressive and destroyed children.

That is what I have tried to portray to you today. That remains our challenge.