Asiasiga: a Samoan intervention to address the immediate mental health needs of Samoan communities after a tsunami.

OBJECTIVE: To describe an Indigenous Samoan psychosocial intervention developed to address the mental health needs of affected communities in Samoa following a tsunami. METHOD: A partnership was established between Samoan therapists, Samoan Catholic pastoral workers and non-Samoan mental health clinicians, informed by Samoan concepts of self and wellbeing. The format developed for visits to significantly affected households was based on a Samoan cultural practice known as asiasiga and was carried out by pastoral workers, with daily group supervision and access to mental health professionals. RESULTS: Household visits were offered to affected families in villages throughout southern and eastern Upolu and the island of Manono. There was a high degree of acceptance of the programme by Pulenu'u (village governance leaders) and family leaders and members. CONCLUSIONS: Mental health responses to the needs of Indigenous Pacific communities following a disaster need to be embedded in the values of those communities. The Samoan practice of asiasiga contributed to the high degree of acceptability of this programme. Partnerships with churches, schools and other local organisations are likely to enhance acceptability and participation. More research is required on Indigenous Pacific post-disaster mental health programmes.

Vanuatu Psychiatry Mentorship Programme: a case illustrating cultural and clinical considerations.

OBJECTIVES: The objectives of this article are to describe a case highlighting challenges in managing an acute psychiatric presentation, the process of mentorship and the significance of cultural matters influencing family engagement in Vanuatu. METHOD: Case description. RESULTS: This case highlights resourcing constraints facing a small mental health team in the Pacific, the clinical significance of the concept of tabu in a ni-Vanuatu context and the importance of family decision making processes in ni-Vanuatu culture. CONCLUSION: A structured mentoring programme to foster mental health capacity development in Vanuatu can support psychiatric decision-making in complex cases, reflection on the role of culture in formulation and family engagement, and mutual learning.

Asiasiga i A'oga ma Nu'u: a child and adolescent post-tsunami intervention based on Indigenous Samoan values.

OBJECTIVE: To describe a community-based single-session group intervention designed to address psychosocial needs of Samoan young people following a tsunami. METHOD: This programme resulted from collaboration between Samoan therapists, Samoan Catholic pastoral care workers and non-Samoan mental health clinicians. Informed by Samoan concepts of self and wellbeing, it incorporated cultural and spiritual practices familiar to Samoan young people and their families as well as body-centred therapeutic techniques, the 'Tree of life' exercise and provision of a cooked meal. RESULTS: Following household visits to affected families in villages throughout southern and eastern Upolu and the island of Manono, the programme was devised and carried out in 11 villages with 1295 children participating. There was a high degree of acceptance of the programme by Pulenu'u (village governance leaders), young people, their families and community members. CONCLUSIONS: Interventions to address the psychological needs of Indigenous Pacific children and adolescents following a major disaster need to be embedded in the values of their communities. This paper describes an innovative programme based on Samoan values that was consistent with evidence-informed principles used to guide post-disaster responses.

The Vanuatu Psychiatry Mentorship Programme: supporting the development of a fledgling mental health service in the Pacific.

OBJECTIVE: To describe the Vanuatu Psychiatry Mentorship Programme (VPMP) set up to support the sole mental health doctor and local nurses developing mental health service capacity in Vanuatu. METHOD: Following a request from Vanuatu, the VPMP was set up under the auspices of the Faculty of Child and Adolescent Psychiatry of the Royal Australian and New Zealand College of Psychiatrists (the College) with three components: regular online supervision, yearly onsite visits and advice over the Internet on an as-required basis. RESULTS: Onsite visits undertaken by three VPMP psychiatrists provided opportunities for mentoring and teaching activities related to clinical psychiatry, community liaison, social and ethical considerations and mental health policy matters. Online supervision sessions were initially hampered by technology difficulties. Ad hoc advice over the Internet allowed more rapid responses in complex acute psychiatry cases. CONCLUSIONS: Structured mentoring programmes can play a role in supporting the development of mental health capacity in low-resourced Pacific nations. Such programmes are likely to be more useful for Pacific participants if they are flexible, ongoing, sustained by support from the College and reviewed regularly.

Pasifika Study Group: a child and adolescent mental health capacity building and leadership workshop with Pacific nations doctors and psychiatrists.

OBJECTIVE: To describe the Pasifika Study Group (PSG), a biennial workshop for Pacific nations psychiatrists and doctors working in psychiatry under the auspices of the Royal Australian and New Zealand College of Psychiatry Faculty of Child and Adolescent Psychiatry. METHOD: Since 2013 the PSG has brought together doctors and other health professionals from eight Pacific nations for a two-day study group. RESULTS: On evaluation the PSG is considered informative and relevant and participants were generally confident of adapting the material to their own context. CONCLUSION: The PSG demonstrates a successful approach to regional engagement in mental health in the Pacific region.

He korowai o nga tipuna: Voice hearing and communication from ancestors.

OBJECTIVE: This article describes the voice hearing experiences of a young Maori man, and the joint Maori healing and psychiatry assessment he received, in which the Maori healer (WN) concluded that some of the young man's experiences could be accounted for by ancestral kaitiaki (spiritual guardians). CONCLUSIONS: Kaitiaki are commonly accepted in Te Ao Maori (the Maori world) as an explanation for some types of voice hearing experiences. Collaboration between a Maori healer and a psychiatrist can offer Maori whanau (individuals and families) more appropriate mental health assessment and intervention than conventional psychiatric assessment alone when Maori spiritual experiences are suspected.

Huarahi Oranga: an introduction to Maori concepts informing a Maori healing and psychiatry partnership.

OBJECTIVE: The aim of this article is to give an overview of Maori concepts informing a collaboration between a Maori healer (NiaNia) and psychiatrist (Bush). CONCLUSIONS: Wairua (spiritual) problems can resemble psychiatric disorders or symptoms. Knowledge of relevant Maori concepts such as mauri, tapu, mana, matekite and manaakitanga may assist psychiatrists in collaborating with Maori healers and kaumatua (elders) to enable more appropriate cultural and clinical assessment, as well as helping to build rapport and clinical interactions with Maori whanau (individuals and families).

Te Ara Waiora a Tane: a kaupapa Maori mental-health assessment and intervention planning approach.

OBJECTIVE: The aims of this paper are to describe a Maori approach to assessment and intervention planning using the Maori creation narrative Te Ara a Tane (The Journey of Tane) and to outline an evaluation one year after the model was implemented. CONCLUSIONS: Te Ara Waiora a Tane is a kaupapa Maori (Maori-centred) mental-health engagement, assessment, goal setting and planning approach designed to enhance the mana (spiritual and personal authority) of whanau (individuals and family/families) at the point they enter a Maori service and during ongoing mental-health work. Preliminary evaluation indicated that staff considered the model user-friendly and helpful for whanau. Further evaluation is needed to assess the impact of this approach on Maori whanau engagement with services.

A partnership between Maori healing and psychiatry in Aotearoa New Zealand.

This paper describes an example of Maori healing and psychiatry working together in an Indigenous mental health context in Aotearoa (New Zealand). Each author outlines their perspectives on the context and the partnership. The case of a Maori teenager with pseudo-seizures and voice-hearing is described to illustrate the partnership in action.

Voice hearing and pseudoseizures in a Maori teenager: an example of mate Maori and Maori traditional healing.

OBJECTIVE: The aim of this paper is to describe a Maori traditional healing approach to assessment and treatment of distressing psychiatric symptoms in a young man. METHOD: We describe the case of a 17 year old Maori male with voice hearing and pseudoseizures and the assessment and intervention by one of the authors (WN). We report on the young man's and his family's experience of this treatment. We outline concepts from a Maori world view that illuminate an indigenous rationale for this approach. RESULTS: A single session traditional Maori healing intervention was associated with immediate resolution of this young man's psychiatric symptoms and restoration of his sense of wellbeing, despite cessation of antipsychotic treatment. He and his family felt satisfied with the cultural explanation about the origin of his distress, which was congruent with their world view. He remained well at follow-up one year later. CONCLUSIONS: Collaboration between psychiatrists and traditional Maori healing practitioners can enhance the mental health care of Maori whaiora (service users) and their families. Indigenous research is required to further evaluate the acceptability and effectiveness of such joint approaches.

A Samoan perspective on infant mental health.

This paper describes background to the development of the relatively new field of infant mental health and why this may be important for Pacific communities in Aotearoa/New Zealand (NZ) and elsewhere. There is a discussion of Samoan concepts and research that could inform infant mental health theory and practice. A Pacific home visiting programme based at Taeaomanino Trust in Porirua, Aotearoa/NZ has formed a collaboration with child and adolescent mental health service clinicians with an interest in infant mental health, to further develop infant mental health understandings and practices in this early intervention service. The benefits and practical application of this collaboration are discussed. The paper ends with a personal perspective from one of the authors on her Samoan reflection on the relevance of attachment ideas to her family relationships and work with Pacific infants, mothers and their families.

Development of a child, adolescent and family mental health service for Pacific young people in Aotearoa/New Zealand.

This paper describes the development of a dedicated Pacific child, adolescent and family mental health service based in Porirua, Aotearoa/New Zealand (NZ). Particular reference is made to, firstly, the social and demographic characteristics of the population we serve, and referrals to our service, and secondly, to key Samoan research findings which emphasize the Samoan relational concept of self as a fundamental concept underpinning Samoan notions of mental wellbeing'. We discuss the practical application of this concept in our work with Samoan and other Pacific young people and their families, including implications for engagement, assessment and treatment processes.

Ole Taeao Afua, the new morning: a qualitative investigation into Samoan perspectives on mental health and culturally appropriate services.

OBJECTIVES: The first objective was to develop a culturally appropriate research method to investigate Samoan perspectives on mental health issues. The second objective was to apply this to identify cultural values and understandings important in the care and treatment of Samoan people with mental health problems. METHOD: Gender-specific focus groups consisting of Samoan elders and service providers were facilitated by Samoan researchers in the Samoan language. Systematic analysis of the transcripts, adapted to the cultural context, were conducted in Samoan and later translated into English. RESULTS: A culturally derived method, referred to as Fa'afaletui, reflecting Samoan communal values and familiar institutional structures within the community, allowed each focus group to come to a consensual view on issues discussed. The Samoan self was identified as an essential concept for understanding Samoan views of mental health. This self was described as a relational self and mental wellness as a state of relational harmony, where personal elements of spiritual, mental and physical are in balance. Mental ill health was sometimes linked to breaches of forbidden and sacred relationships, which could be addressed effectively only within protocols laid down in the culture. Additional stressors contributing to mental ill-health were identified as low income, unemployment, rising housing costs and the marginalization of Samoan cultural norms in New Zealand. Participants identified the need for a culturally based mental health service for Samoan people to address key cultural factors. CONCLUSIONS: The Fa'afaletui method is a new research method which is sensitive and responsive to Samoan cultural norms and is methodologically rigorous. Such an approach may be relevant for other Pacific Island cultures and other cultures, which have a strong emphasis on collectivity. The Samoan concept of self provides a theoretical foundation for understanding the mental health needs of Samoan people and a basis for developing appropriate services.

Samoan and psychiatrists' perspectives on the self: qualitative comparison.

OBJECTIVES: To compare psychiatrists' perspectives on the meaning of self, in general adult public practice psychiatry in the Wellington region of New Zealand, with a Samoan view of self and to discuss the implications for the practice of psychiatry with Samoan people in New Zealand. METHOD: A focus group of psychiatrists was convened for three sessions. A Samoan view of self was presented to the participants. Transcripts of the focus groups were analysed using inductive content analysis and a process of cultural accountability was included in the research design. RESULTS: Individual and secular notions of self dominated the psychiatrists' perspectives and contrasted with the primacy of relational and spiritual notions of self in Samoan culture. Psychiatrists experienced a sense of cultural 'dissonance' on first exposure to the Samoan views. The Samoan notion of self was considered to challenge the universalist assumptions of Western psychiatric theories as understood by the participants. The Samoan relational notion of self had implications for clinical interviewing, understanding of phenomenology, formulation and treatment planning with Samoan patients and their families. CONCLUSIONS: Dedicated Samoan or Pacific Island mental health services would allow culture-specific concepts central to an understanding of mental health to be embedded in service delivery. The process used in this study and the notion of dialectical tension could be used in the cultural education of mental health clinicians. The cultural accountability process models an important aspect of such training.