Investigation Of Māori Perceivement Of Mental Health Diseases, Espesially Dementia

Dementia

Dementia is increasing worldwide, around forty-seven million people live with dementia in 2015, and this is expected to triple by 2050. Dementia affects the individual, whānau (extended family) and wider society because people with dementia also require health and social care. The financial burden associated with dementia is alarming and estimated to be two point seven billion NZ dollars by 2030. Thus, highlighting the need for quality data, to assist high-quality services which will contribute and ease some of the burdens associated with this disease.

Dementia is a major health problem for Indigenous people, yet very little is understood about this condition from Indigenous perspectives. The societal burden of dementia among minority ethnic groups is well established. Conversely, information about how Māori, who are indigenous to Aotearoa (NZ), understand deteriorating states of Mental health within Kaumātua (Māori elderly) community or perceive the Western concept of dementia is lacking. Culture plays an integral role in the way old age is understood, experienced and managed, in spite of this, dementia, as understood from a Western perspective, implies that all experience the disease in the same manner.

Dementia, as defined by the Western Biomedical model, is a progressive impairment of brain function, a neurodegenerative disorder often associated with widespread deterioration of mental functioning and social capabilities. The most common dementia type is Alzheimer’s Disease, followed by Vascular Dementia which accounts for ten per cent or more of all dementias. The other common subtypes include Dementia with Lewy Bodies and Frontotemporal dementia. Dementia is a chronic and progressive condition that is generally associated with ageing. Although, dementia is not a standard consequence of ageing and manifests markedly differently across individuals. There is a range of symptoms which can include, confusion, memory difficulties, challenges in planning or problem solving, communication, changes in mood and personality, and at times psychotic symptoms and movement disturbances. Excluded from current definitions of dementia are cultural understandings of the disease.

Kaumātua and Dementia

Kaumātua are highly valued in the Māori community, they are viewed as the pillars of strength who guide, protect and are often the guardians of tikanga (custom). According to Kereopa (2003), the meaning of kaumātua is to “wade through something” because once you reach this later stage in life you have navigated through experiences of life. From here you have a deeper understanding and appreciation of life. To better inform healthcare for whānau experiencing dementia, it is paramount that knowledge and understanding from a Māori cultural perspective are included across health board disciplines. Kaumātua are living longer. In the last decade, the number of Māori living beyond the age of eighty years has doubled. This trend is predicted to continue resulting in an increase in the number of kaumātua who will be affected by age-related diseases like dementia. It is predicted that by 2026, that 5. 8% of the Māori population will be estimated to have dementia, which is a total of 4, 493 affected individuals. Although, the prevalence could be a lot higher because often those with dementia remain undiagnosed.

Also, the actual prevalence rates of dementia recorded for Māori are not likely to be true reflection as kaumātua are less likely to access primary care services and mental health services. Dudley (2018) states there is a significant need to know the extent of the problem of dementia in NZ, to help counteract identified modifiable risk factors. Risk factors such as hypertension, diabetes stroke incidence, alcohol use and other risk factors which are highly prevalent amongst Māori. This information will enable kaumātua and whānau to become more proactive, empowering whānau to create a pathway towards changes that mitigate these risk factors. Thus, bringing instrumental changes in their support for the prevention of the onset of dementia for kaumātua. As dementia is a major rising health challenge in NZ there is a need to increase literature regarding Māori and dementia, which will help to provide information to support, manage and cope, easing some of this burden for whānau, hapū (kinship group), iwi (extended kinship group) and society.

Māori Health

Positive Māori identity equates with good health and well-being. Colonisation had a considerably harmful impact on Māori identity. The events of Colonisation, The Tohunga Suppression Act (1907) which outlawed Māori modalities of healing, and assimilation agendas of schools and churches, as well as, urbanisation have effectively severed Māori ways of communicating and transmitting health practices. The injustices Māori have experienced from colonisation echo those of Indigenous peoples through the world. Māori now inhabits a vulnerable position in NZ society. Despite making up approximately 15 percent of the total population, Māori suffers disproportionately from mental ill-health. Supporting Māori in treatment has emphasised the importance of understanding who Māori are. In contemporary times defining Māori identity is multifaceted, a heterogeneous group where individual characteristics are intertwined within a number of cultural, socio-economic collective realities. Past history events have real everyday implications for Māori, and not all Māori have grown up in a “customary” setting, and the significance of “traditional” values is not the same for every Māori. However, Māori identity is an inclusive approach, and regardless of the different expressions of Māori identity and varied realities, all the uniqueness and diversity are accepted. Fundamentally, Māori identity is important as it provides a self-identification, belonging and access to various aspects of Māori culture and collective well-being.

Māori health perspectives are often summarised as holistic, and incorporate mind, body and spirit within a social context of cohesion. Holistic healing includes the relationship with the land and natural environment, whakapapa (genealogy), tikanga, and language. Further, Māori health is intrinsically linked with whānau, hapū and iwi and supported by a balance of a number of dimensions, such as Te Whare Tapa Whā (developed by Mason Durie, 1995). Where health and well-being are achieved through a sense of balance in four areas; taha hinengaro (mental wellbeing), taha tinana (physical wellbeing), taha wairua (spiritual wellbeing) and taha whānau (familial relationships and connections). The Meihana Model, which extends on Te Whare Tapa Whā, and symbolises a waka Hauora (double-hulled canoe) representing the balance between client, whānau, relevant presenting issues and treatment plan. While also putting these issues in the context of colonisation, racism, migration and marginalization. Both models emphasise balance across a number of personal, environmental, cultural and spiritual dimensions. Dominant Western models of health traditionally have divided these areas and concepts of identity and health, with a focus based on individual autonomy. This creates barriers to access health care due to cultural inappropriateness and irrelevancy. Western models of health and approaches to health service delivery directly impact Māori access to and use of health services, as well as, the quality of care the whānau receive. The inequalities continue into older age, which creates a further burden, stress and exclusion for whānau who are caring for kaumātua with dementia. Literature and awareness about the impact of colonisation and the importance of the Te Tiriti o Waitangi (Treaty of Waitangi) is growing and highlights the right of Māori to make decisions about their own healthcare, and attainment of equity of health status and well-being. Barriers to dementia care directly impact whānau, caregivers and society on every level, physically, emotionally, psychologically and economically.

Māori and whānau careWhānau is central to Māori identity and health. Huriwai (2001) states that in contemporary times whānau are people who do not necessarily have whakapapa links but who come together for particulars shared purposes. Bound by aroha (love, sympathy, charity) and other Māori values like tika (rights, authentic) and pono (truth). Whanaungatanga is kinship in its broadest sense and strengthens the commitment and connection of whānau members to one another and their responsibilities in these relationships. Māori philosophies of care, which included those who were mentally unwell, were founded on integrated and inclusive models which emphasised holism, integration and whānau, hapū and iwi connections. The idea that those needing care should be removed from society, and away from their extended whānau was uncommon in traditional ideas of Māori health. Kaumātua who have dementia are more often likely to be cared for within the hapū or whānau which can lead to incredible psychological and financial stress on the caregivers, especially with an urbanisation shift from the former traditional ways of living. However, as it is key to Māori culture and way of being it is often viewed as a collective responsibility rather than a burden, which emphasise the need for more research on how Māori perceive the deteriorating state of mental health to be better inform health care and really help and support whānau.

The importance of Māori culture, mātauranga (knowledge), rongoa (medicine), karakia (ritual chants) tikanga and values need to be the central perspective when it comes to healthcare for whānau experiencing dementia as they are protective factors for many Māori. Further, there is a growing body of research which shows that cultural perspectives are key to understanding the experiences of dementia. Dudley (2018) states that the importance of culture in dementia care is evident in the concept of tapu (sacredness of relationship). Mātauranga Māori emphasises the importance of a person's head and hair from ordinary secular association and use. This means the head has a prohitibive aspect so it cannot be interfered with or trangressed. For instance, food which is considered as noa (free from tapu restriction) cannot be lifted above a person’s head due to its tapu nature. If tapu is breached it leaves the person vulnerable to divine retribution which could be illness, death, mental ill-health or misfortune. Tapu can have variations in meaning depending on your whānau, hapū and iwi and area you come from. However, what is evident is that any knowledge surrounding such important aspects of Māori culture are not considered in Western models of dementia care. Further impacting and disadvantaging the already vulnerable and creating more barriers to whānau and care.

Thus, highlighting the significant need for more research on how Māori perceived deteriorating states of mental health. This will better inform healthcare for whānau experiencing dementia and help reduce some of the barriers to dementia care. Enriched understanding of what kaumātua find to be supportive or discouraging in the concept of dementia will allow kaumātua to make their own decisions about healthcare. In a way which supports and honours their own mana, tapu and aligns with Māori culture, values, beliefs and understandings.