Te hohounga: Mai i te tirohanga Māori The process of reconciliation: Towards a Māori view


Te Whare Tapa Wha: A Māori model of health



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Te Whare Tapa Wha: A Māori model of health


There are a variety of Māori models related to health and wellbeing, including Te Wheke (Pere, 1991), Nga Pou Mana (Henare, 1988), The Gallery of Life (Te Roopu Awhina o Tokonui, 1988). A consistent theme of these models is the holistic approach and the need to address wairua at some level. In essence, the conceptualisation of conduct problems from a Māori view points to the need to address the issue from a holistic approach. The focus on identity and connections also signifies the importance of wairua and whānau. Te Whare Tapa Wha is presented here as a model of wellbeing, relevant to the development, implementation and evaluation of programmes working with Māori tamariki, taiohi and whānau experiencing conduct problems.
Te Whare Tapa Wha was first presented at a Māori Women’s Welfare League hui in 1982. In 1985, Mason Durie published a paper called A Māori perspective of health, which outlined differences in perspectives towards health by Western society and Māori. Durie presented a ‘traditional perspective’ of Māori health as being a ‘four sided concept representing four basic tenets of life’ (Durie, 1985, p. 483). The balance and symmetry with each of these tenets were essential for wellbeing. The four components of wellbeing are; te taha wairua (spiritual wellbeing), te taha hinengaro (mental wellbeing), te taha tinana (physical wellbeing) and te taha whānau (family wellbeing). The essential feature of Te Whare Tapa Wha is that it takes a holistic perspective to wellbeing, and that to achieve wellbeing, or health, each component needs to be in balance. In 1985, Durie noted that the limitation of many contemporary health services was in relation to addressing the spiritual dimension.
Twenty years later, ACC commissioned a literature review to explore Māori models, frameworks and strategies that could relate to injury prevention and health promotion and provide a review of evidence-based interventions within Māori communities and other indigenous literature pertaining to injury prevention and health promotion (Cherrington & Masters, 2005). The review found that Te Whare Tapa Wha (Durie, 1985) was being used as a framework for services in a range of sectors including policy, health, mental health, public health, education, justice and Kaupapa Māori health services. The model was also being endorsed as a framework in mental health outcomes with the potential to be used in both generic and Kaupapa Māori mental health services (Kingi & Durie, 2000).

In programmes working with Māori tamariki, taiohi and whānau with conduct problems, the use of Te Whare Tapa Wha is dependent on what sector and what service the person and whānau is seeing. In 2003, under the Capital and Coast District Health Board (C&CDHB), a Regional Rangatahi Adolescent Inpatient Unit (RRAIU) was established as a bicultural unit providing inpatient beds for adolescents throughout the North Island requiring hospitalisation for mental health problems. RRAIU assessment processes and treatment plans are based on Te Whare Tapa Wha and ensure all components of a person’s wellbeing are addressed (L.Laphen, personal communication, 2005).


In 2004, the Lower North Island Severe Conduct Disorder Unit was opened in Epuni. The frameworks of Puao-te-ata-tu (Department of Social Welfare, 1988) and Te Whare Tapa Wha were outlined as the frameworks from which the service was to be delivered. The aim of the service was to provide an inclusive bicultural approach and to develop clinically and culturally relevant treatment, interventions and specialist care to young people/ rangatahi experiencing severe conduct problems and a co-existing mental health difficulty. Although not addressing children and adolescents, Te Whare Tapa Wha has also been used in a criminogenic programme for woman offenders, Kowhiritanga (King & Cherrington, 2004), and at the Montgomery House violence prevention programme.6

In providing a Māori view around conduct problems, TRK recommended that culturally relevant best practice must include whānau. In addition, programmes required an:



Integration of clinical, cultural and social dimensions of interventions to achieve effective outcomes. (TRK, cited in AGCP, 2009:42)
In essence, TRK advocated for a holistic approach to assessment and treatment when working with Māori tamariki, taiohi and whānau experiencing conduct problems.
Te taha whānau

Te taha whānau refers to family wellbeing, as in whānau ora. Durie (1998) describes this component as incorporating the capacity to belong, to care and to share. Te taha whānau also refers to one’s relationships in a variety of contexts. In relation to tamariki and taiohi with conduct problems, such relationships would include relationships with peers, relationships within the school system, siblings, immediate whānau, extended whānau, hapū and iwi connections. Family relationships such as the parent unit, siblings, kuia and kaumatua (elders), teina (younger sibling) and tuakana (older sibling) roles are all a part of te taha whānau.


In addition, both contemporary and traditional concepts of whānau and the obligations that go along with this may or may not be evident. The concept of whanaungatanga (connectedness) is also important when considering whānau wellbeing, and also a child’s and young person’s ability to belong, to be a part of and to share within their biological whānau and appointed whānau (that is, peers/ gangs/ romantic relationships). In essence, when there are healthy relationships in different contexts, the individual within the wider system is able to receive appropriate physical, emotional and spiritual nourishment.
As highlighted earlier, a Māori perspective of conduct problems needs to be conceptualised from a whānau perspective. Not only do the needs of the young tamariki and/ or taihoi need to be considered, but so do the needs of the whānau when formulating assessment and treatment plans for Māori tamariki and taiohi with conduct problems. Individual and whānau identity are both important and intertwined.
As noted in many families with conduct problems, families themselves present with a variety of complex issues (AGCP, 2009b). The families’ level of criminal activity, homelessness, violence, alcohol and drug use, employment, support, income and adult mental health issues are variables that impact on whānau wellbeing and need to be addressed in interventions focused on the whole unit. Peta Ruha, programme manger of the Lower North Island Severe Conduct Disorder Unit, described the realities of the whānau and young people coming into their service:

  • we are working with mostly gang families

  • there is serious poverty

  • it is mostly the ‘Mum’s’ doing the fronting

  • there are multiple layers of issues.

A reality for some taiohi is that they are parents or about to become parents. Issues related to whangai (adoption) within the whānau or the whānau’s ability to support the taiohi and a mokopuna are important for many Māori whānau. Te taha whānau is about relationships with immediate whānau and whānau where there are whakapapa (genealogical) links, whether or not these links are known and whether or not there is a relationship. Interventions for many Māori youth and whānau may centre on establishing links with whānau, hapū and iwi.


Te taha whānau also refers to relationships with persons in their wider social network, including gangs, sports groups, church and other community initiatives. Other very important relationships include those the young tamaiti or taiohi is forming (or in some cases not forming) with professionals who have become involved because of conduct problems. Social workers, youth aid officers, teacher aids, court-appointed psychologists, psychiatrists, cultural workers and doctors are some of the professionals that may be involved. The types of relationships formed with these professionals are important to engagement and retention of whānau in a potentially therapeutic process that could assist in reducing the escalation of problematic behaviours.
In essence, te taha whānau as highlighted by Durie has the potential to be used as an intervention strategy. Whānau includes the many systems that the individual and their whānau are involved in. This is not dissimilar to aspects of multi-systemic therapy. However, in line with the intent of Te Whare Tapa Wha, te taha whānau can not be viewed in isolation, and interventions need to address all aspects of wellbeing.

Te taha hinengaro


Te taha hinengaro refers to mental wellbeing, and includes psychological processes. Thoughts, feelings, cognitive functioning, thinking styles are aspects of te taha hinengaro. Pere (1991) also described te taha hinengaro as a combination of the conscious and subconscious. As a result, te taha hinengaro also refers to mental processes and intuition. Durie (1998) describes te taha hinengaro as the capacity to communicate, to think and to feel. In relation to conduct disorder, additional issues relevant to Māori tamariki and taiohi might include:

  • communication styles of individual and whānau

  • ability for person and whānau to communicate in Māori

  • understanding of what is happening, legal consequences, court processes, comprehension

  • beliefs about why this is occurring

  • mental state/ emotions/ mood

  • whakamā (shyness/ embarrassment – individual and whānau)

  • pōuri (depression)

  • anger and expressions of from individual and whānau

  • motivation to make changes individual and whānau

  • engagement with professionals and programmes

  • learning difficulties

  • cognitive abilities

  • strengths and weaknesses of personality

  • attitudes about their own behaviour.



Te taha tinana


Te taha tinana refers to physical health and can include the physical environment within which a tamariki or taiohi lives. Durie (1998) refers to te taha tinana as the capacity for physical growth and development. Te Roopu Awhina Tautoko (1987), in describing this component, also acknowledges a spiritual connection:

Taha tinana is turning to nature for herbal compassion, utilising rituals for physical appeasement, keeping the soul and body intact. (Te Roopu Awhina Tautoko, 1987:7)
The concepts of tapu and noa (sacred and not sacred) are also used in relation to the body and, in essence, provided safe, healthy and hygienic practices traditionally. In contemporary society, viewing the body as tapu, and therefore giving the body the appropriate respect by not damaging it through drugs, poor diet and lack of exercise, is a Kaupapa Māori perspective towards hauora (wellbeing) and a healthy life style. Given there are numerous physical health disparities between Māori and non-Māori, physical growth and development is imperative for Māori tamariki and taiohi.
Te taha tinana can also refer to the physical environment, and includes variables such as housing, employment, income, schooling and daily activities, all of which can impact on the wellbeing of the individual and whānau. The importance of turangawaewae (place of identity/ belonging), being brought up in the area where you are from, having contact with your turangawaewae and how often etc. are all aspects of te taha tinana that can impact on one’s wellbeing. The connection to the physical land highlights how spiritual and whānau components are intertwined with taha tinana.

Te taha wairua


Te taha wairua is probably the most difficult area to define, assess and understand, yet it is the most important area and is intertwined with every other component of wellbeing. Te taha wairua refers to spiritual wellbeing, and is not just inclusive of religion. Kingi (2002) describes te taha wairua as including beliefs in a non-physical dimension or force. Durie refers to te taha wairua as the capacity for faith and wider communion, and states that health is related to unseen and unspoken energies (Durie, 1998:70). Te taha wairua also acknowledges the relationship a person has with the environment and their ancestors. The following poem highlights the many facets of te taha wairua:

Wairua


By Heather Delamere Thomson

Koro, what is wairua?” the child asked, eyes wide



Wairua, my moko is what gives us life

Handed down to us from a time past

At the moment of your beginning

You shared with me the wairua of your tipuna:

For I am your link with the past

And you are my link to the future

The aroha of the whānau has wairua

And their words, their laughter, their tears

The marae, tangi, waiata and whakapapa

Have a wairua that strengthens us, gives us pride
So too the sunrise and sunset

The soft summer rain, the raging storm,

The song of the birds in the trees,

The waves on the beach

The mist rising from the bush

The moonlight on the water

And the embracing darkness of the night
To sit quietly in the wharenui or the urupa

And feel the presence of your tipuna is to feel wairua

Your arms around my neck, your breath on my cheek,

Fills me with a special wairua

For there is wairua in all things that give meaning to life

To love, to the future.
So moko, open your mind,

Let your heart love

Your eyes see

Your ears hear

Your hands feel

Give of yourself, my moko

For in giving, you receive

And the wairua grows.”
In relation to tamariki, taiohi and whānau experiencing conduct problems, an important goal is to ensure that their taha wairua is in balance. For many deculturated youth and whānau, it is about reconnecting to their sense of wairua and what makes them feel strong spiritually. Te taha wairua also refers to beliefs around tapu (sacred) and noa (safe), makutu (Māori curse), mate Māori (Māori illness), use of rongoa (Māori medicine), karakia (incantation), taonga (treasure) and tangihanga (funeral). These aspects of Te Ao Māori are better left to be assessed by Māori knowledgeable in these areas. However, this does not preclude generic and Kaupapa Māori practitioners gaining an understanding of what te taha wairua may mean for whānau and individuals, without needing to go into an indepth cultural assessment. Simply finding out what makes a person feel centred and uplifted in some way, such as listening to music, going to the ocean, laughing with one’s children, is an important component of te taha wairua.
Hua Oranga is a Māori mental health outcomes measure developed by Kingi and Durie (2000) and is based on Te Whare Tapa Wha. Through extensive consultation and hui through the country with key stakeholders, the researchers identified components within each taha as a way to evaluate outcomes of interventions. The measure requires a triangulated approach to evaluation where the clinician, whānau and tāngata whaiora (client seeking wellbeing) complete the form. In relation to te taha wairua, the questions and components used n Hua Oranga are detailed to expand on an understanding of te taha wairua. Four dimensions are identified under te taha wairua:

    1. Dignity and respect – feeling valued as a person

As a result of this intervention do you feel more valued as a person?


    1. Cultural identity – strong as a Māori person

As a result of this intervention do you feel stronger in yourself as a Māori person?


    1. Personal contentment

As a result of this intervention do you feel more content within yourself?


    1. Spirituality

As a result of this intervention do you feel healthier from a spiritual viewpoint? (Kingi, 2002: 428).
These questions highlight the many facets of wairua, including a sense of dignity and respect, cultural identity and personal contentment in conjunction with a person’s own sense of spirituality. While many programmes focus on te taha hinengaro or te taha whānau, a Kaupapa Māori approach would ensure that all taha were addressed in a therapeutic intervention, not only for the individual but also for the whānau. The potential and scope for te taha wairua interventions are many and varied and could range from simply having therapy sessions by the moana (sea) or wananga (learning) in a whare nui, to more cultural-specific interventions such as Mau Rakau or Kaupapa Māori activity-based programmes. However, it must be noted that these types of interventions are not just spiritually based but also holistically focused.

Whakataunga: Conclusion


Te Whare Tapa Wha has been talked about and used in a variety of settings over the last 25 years. It has become a well-known model that is easily understood and has the potential to be useful for Māori and non-Māori. Practitioners and service providers need to consider the use of Te Whare Tapa Wha or a similar model to ensure they take a holistic approach when working with Māori tamariki, taiohi and whānau.
By using Te Whare Tapa Wha in the assessment process, a comprehensive treatment plan can be developed. Ideally, if Te Whare Tapa Wha was used across sectors, a more unified approach towards treatment could be obtained. The essential feature of such a framework would be for the whānau as a whole to address each area as well as the identified symptom bearer or tamariki or taiohi with conduct problems. By utilising a holistic approach, the complexities of working with hard-to-reach whānau can be more fully assessed and addressed.



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