In narrative therapy, Māori creation stories are being used to heal
by MICHELLE DUFF, Stuff, March 9 2018
The boy sits there, his head down. He feels stink; he knows all the adults are there to talk about him, about what’s wrong with him.
He’s always been told off for being so fidgety, for not paying attention. He knows it’s a bad thing.
But when the talking begins, it’s not about how to fix him. They’re telling a story about atua, the gods, and one of them sounds exactly like him! He’s called Uepoto, and he’s always curious. He’s full a mischief, a tutū.
The boy looks up.
“That’s where the healing starts, with an exchange of words,” says Poutu Puketapu, 25, a mental health worker at Gisborne service Te Kūwatawata. Only, that’s not his title here – in this space he’s a Mataora, or change-maker.
And the boy isn’t a patient, or client, or even a consumer. He is simply whānau.
“Instead of labelling them and making them feel like they are part of the mental health system, we reach them with these narratives. When they hear the pūrākau (stories) you see a little spark in them.”
Mahi a Atua is a form of narrative therapy that focuses on recovery from the trauma of colonisation. Māori creation stories are used as a form of healing, connecting alienated Māori to their whakapapa.
The pilot programme began in August last year as a response to the disproportionate mental health issues among Māori, and is backed by the Ministry of Health’s innovation fund and Hauora Tairāwhiti District Health Board.
Māori youth are two-and-a-half times more likely than non-Māori to commit suicide. Māori in general are more often underdiagnosed, and once in the mental health system are more likely to be secluded and imprisoned.
Mahi a Atua is driven by Dr Diana Kopua, an Otago University Māori health academic and clinician who is Head of Psychiatry at the DHB, and her husband Mark Kopua, a tohunga and Tā Moko practitioner.
And in Gisborne, it’s seeing change. Since Te Kūwatawata opened six months ago, the number of urgent callouts to the traditional psychiatric and assessment treatment team has halved.
And referrals to the DHB’s child and adolescent mental health team, a specialist service, have dropped from an average of 70-90 a month to between five and 10. “This is because we are seeing families without the need for any wait time, and seeing them intensely and supporting them to overcome their problems without the need to refer them,” Kopua says.
After graduating from her first degree at Whitireia Polytechnic in 1993, Kopua became the first Māori mental health nurse employed in Porirua.
“I saw Māori being bought to hospital for admission in police cars, it was almost like they had lost their physical existence they were so broken,” Kopua, who is Ngati Porou, says.
“I saw the system use up its Māori workers being that bridge to get them into the hospital. I was seeing, and still am, Māori being overmedicated. If one doesn’t work, let’s add another one, and another one. I saw complacency.”
After taking a year out to learn Te Reo Māori, Kopua began developing Mahi a Atua. Working with troubled teenagers, she would re-tell them pūrākau, the stories of various atua, or gods.
Whānau were involved in these sessions, where it was discovered which atua the teen related to, and the challenges they shared. With a role model from their own genealogy to compare to, the teen could anchor themselves to a positive identity.
“You can’t know your identity if you don’t know your whakapapa. When we used stories, I wasn’t imposing my Western beliefs,” Kopua says.
“With something like ADHD, Western medicine isn’t looking at historical and social determinants, poverty – when there’s an obvious link between these and mental health problems. The solutions lie in looking at the history of colonisation and that impact, guided by a humanistic response in that room.”
Everything Kopua has done since then – attending medical school, becoming Otago University’s Associate Dean for Tairāwhiti – has been working towards establishing her narrative therapy.
Two years ago, the Ministry agreed to a trial backing of Kopua’s local initiative. In August last year, she and her husband opened the Te Kūwatawata clinic.
The therapy flips the Western format on its head. Instead of a one-to-one diagnosis focusing on the diseases’ cause, Kopua and her Mataora focus on helping the person and their whānau find culturally relevant meaning.
“We use Māori knowledge systems to give Māori a different lens and language to understand problems. We aim to get a lot of feedback when we’re in the room, and we don’t ever talk about that whānau without them present.”
Te Kūwatawata doesn’t look like a mental health service. It looks like an art gallery, and some of the Mataora, like Puketapu, are artists. They will pair up with a qualified clinician to work in a session with a whānau, breaking down the power dynamic of a typical client-doctor relationship.
For many Māori, Kopua says, traditional mental health settings are intimidating. “It’s almost like mental health services are way of colonising people again. You come in, you’re disconnected from your land, your culture, and your language. You can’t articulate values that are part of your ancestry.”
Professor David Tipene-Leach, an outside clinician who helped to co-author a paper about Mahi a Atua in the New Zealand Medical Journal published on Friday, will lead a study into the outcomes of the programme.
“My underlying sense is there is a lot in here we need to take notice of. They are dealing with a group of people who have not previously been well catered for, and they are doing it better and at a lower cost.”
MY BABY WAS HURT’
Tama* was four when he told his mum, Erena, that he had been sexually abused. For several years she was bumped around mental health and rape crisis services, each one unable or unwilling to help.
“I was referred to a lot of people, but I was getting the run around. My baby came to me and told me this at 4-years-old, but I couldn’t find anyone to help. I felt disheartened,” Erena says.
“He wanted answers – ‘Why did this happen to me, what did I do wrong?’ and and I didn’t have those.”
Rape Crisis offered sand and art therapy sessions, but Erena felt it wasn’t what the whānau needed.
“I wasn’t allowed in the room with my son when he was doing his art therapy. He was getting taken away from me and I felt like I was being treated like I was the abuser.”
With “Doctor Di”, the whole family are involved. Her son, previously withdrawn and angry, has shown more progress in five sessions than the past five years, Erena says. Whiro, the god of anger, is his favourite.
“My son loves it. He says ‘I love getting told the stories mum, I understand my feelings’.
“He can relate them back to characters, and realise he’s not the only one out there who has to go through these things. He said to me: ‘I like Whiro, because he’s in a dark place like me’.
“It was sad for me as a mum, but it was healing for me to hear my son start letting some things go. He’s bubbly, he’s starting to be more outgoing, his confidence is lifting, he’s more engaged with the family.”
Puketapu was working as a beekeeper when he was asked by Mark Kopua to train as a Mataora. At first, he just figured it would help him get him closer to Kopua.
“Mark has been my idol since I was really young, along with a lot of young males my age. I eventually got to rub shoulders with Uncle Mark and he introduced me to a needle and applying moko on skin. That was probably the biggest thing I ever achieved for myself,” Puketapu says.
“After applying my first moko he thought it would be a good idea I come to these wananga [training courses] and I was like ‘Oh keen, sweet!’.”
After a few, he was hooked. “I was being enlightened every week with pūrākau and these sophisticated words I’ve never heard about like institutionalised racism and meritocracy. I just kind of got addicted to it.”
He doesn’t feel like it’s a job. Often, once a whānau is ready to leave the service, they will request a moko. For Puketapu, it is an honour.
“It’s like this friendship you’ve built with them, a trust, you don’t want to say goodbye but it’s good because they’re well.
“For me, marking them with moko is a way of healing, and acknowledging what they’ve been through.”
*Names have been changed.