Academic journal article New Zealand Journal of Psychology

Meihana Model: A Clinical Assessment Framework

Academic journal article New Zealand Journal of Psychology

Meihana Model: A Clinical Assessment Framework

Article excerpt

In 1984 Mason Durie documented a framework for understanding Maori health, Te Whare Tapa Wha, which has subsequently become embedded in Maori health policy. In addition, the adoption of this framework is now widespread among Maori and Iwi health and disability service providers and clinicians. Within psychological practice Te Whare Tapa Wha forms the foundation of a number of practice frameworks. This article presents a specific assessment framework, the Meihana Model, which encompasses the four original cornerstones and inserts two additional elements. These form a practice model (alongside Maori beliefs, values and experiences) to guide clinical assessment and intervention with Maori clients and whanau accessing mental health services. This paper outlines the rationale for and background of the Meihana Model and then describes each dimension: whanau, wairua, tinana, hinengaro, taiao and iwi katoa. The model provides a basis for a more comprehensive assessment of clients/whanau that then underpins appropriate treatment decisions.

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When I (SP) was growing up in rural Hawkes Bay there was one question I was constantly asked each year when I returned to school after the summer break: "Did your whanau have a hangi for Christmas dinner?" I always had to answer, "No". This would invariably be met with looks, if not exclamations, of surprise. It was as if I'd broken some unwritten rule about what it meant to be a whanau at Christmas.

Just asking me one question did not reveal the whole story behind my hangi experience. It merely resulted in an absence of knowing about the other things that influenced my response; for example, people also needed to know whether or not my whanau:

* actually got together for Christmas,

* had the knowledge to build a hangi,

* wanted to engage in building a hangi over the hot Christmas period,

* all liked to eat hangi,

* had space and resources available to build a hangi, and

* had an understanding of current council laws about building a hangi during a usual summer fire ban.

Mental health assessment is not that far removed from asking someone about whether their whanau had a hangi at Christmas. Invariably, asking a larger set of questions will lead to a greater knowing about a whanau and their circumstances (Huriwai, Robertson, Armstrong, Kingi & Huata, 2001). The risk for Maori within western-based mental health service delivery is that assessment is not based on a comprehensive set of questions within the appropriate cultural context. There are indications that inaccurate or inappropriate assessment of Maori can lead to misunderstanding, misdiagnosis and mistreatment (Adamson, Sellman, Deering, Robertson, & de Zwart 2006, The MaGPIe Research Group 2005, Wheeler, Robinson & Robinson 2005, Simpson, Brinded, Fairley, laidlaw & Malcom 2003, Brined, Simpson, Laidlaw, Fairley & Malcom 2001).

The introduction of Te Whare Tapa Wha into clinical practice has allowed a wider understanding of the holistic nature of Maori mental health (Rochford 2004, Durie 1994, 2001). Te Whare Tapa Wha identifies four cornerstones of health and likens them to the four walls of a whare. In this way the cornerstones are seen to be interlocking and all essential to the maintenance of health and well-being.

The infiltration of this Maori framework into the delivery of health services to whanau, by iwi and mainstream providers is documented by a number of policy and technical reports (Ministry of Health 2000; Ministry of Health 2002; Ministry Of Health 2002b; Maori Health Committee 2001, New Zealand Guideline Group 2003; Public Health Advisory Committee 2003; Health Research Council 2004; Te Rapuora O Te Waiharakeke 2004; Canterbury District Health Board 2003; Whakapakari 2000) and emerging mental health research publications (Palmer 2004; Glover 2005; Durie & Kingi 1997). Such documentation has begun to clarify how Te Whare Tapa Wha is being operationalised in practice. …

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