Are psychologists meeting the needs of Māori? A perspective from Psychological Services
Senior Adviser, Chief Psychologist’s Office, Department of Corrections
Principal Adviser Special Treatment Unit Development, Chief Psychologist’s Office, Department of Corrections
Senior Lecturer, School of Psychology, University of Waikato
Bronwyn Castell, PhD; PGDipClinPsych, is a senior adviser in the Chief Psychologist’s team. She was contracted into a variety of academic roles at Massey University, and worked in the mental health sector before registering as a clinical psychologist. She has worked in the Department’s Special Treatment Units and alongside local psychology offices to provide assessment services. Her PhD thesis applied the concept of kawa whakaruruhau (cultural safety) to the consideration of spiritual and religious needs in mental health care services. She has continued to expand her interest in the application of kawa whakaruruhau, alongside interests in neuropsychology, psycholegal matters, and the psychology of criminal conduct.
Glen Kilgour, MSc; PGDipPsych(Clin), trained as a clinical psychologist at Waikato University, graduating in the early 1990s. He has worked in the Department since 1995 in a variety of roles including principal psychologist. His interests include reducing violence, programme evaluation, group therapy, young offenders, continuous learning, staff development, and science fiction.
Armon Tamatea, PhD; PGDipPsych(Clin), is a registered clinical psychologist and Senior Lecturer at the University of Waikato where he principally teaches in the post-graduate clinical psychology programme. He was Senior Adviser (Psychological Research) for the Department of Corrections before assuming an academic post where he has continued to develop his special interests in New Zealand gangs in criminal justice, psychopathic personality, and the role of culture in criminal justice and forensic contexts. He currently divides his working time between research, teaching, supervision, and clinical practice.
One of the enduring privileges and challenges in any society is encountering cultural difference. For psychologists, whether in health, education, or criminal justice, the role of culture presents a variety of opportunities to better understand an individual’s behaviour, the context in which it occurs, and directions for enhancing wellbeing, safety, and behaviour change in ways that are meaningful for clients and society. Psychologists who work in the criminal justice arena are only too aware of the cold reality of the over-representation of Māori who come into contact with the system and populate our prisons. Accordingly, observing and attending to the cultural salience of clients’ behaviour, values and communities is a central domain of inquiry for psychologists in the criminal justice space that informs assessment, treatment and reintegrative practices. In this article, we discuss correctional psychology in light of recent challenges to the cultural relevance of psychology in Aotearoa New Zealand.
In 2017, the Waitangi Tribunal considered a claim that the Crown was not meeting its Treaty obligations by addressing the disproportionate rates of re-offending among Māori. The Tribunal found that the Department of Corrections in particular had not upheld the principles of equity and active protection by not prioritising Māori in its efforts to reduce re-offending (Waitangi Tribunal, 2017, WAI 2540 #1.1.1). Corrections accepted the findings of the Tribunal (Department of Corrections, 2017b) and, in the report Reducing Re-offending Among Māori, outlined a variety of strategies to better address disproportionate re-offending rates (Department of Corrections, 2017c). These included four priority areas: (1) providing opportunities for Māori in industry, treatment, and education initiatives, (2) enhancing community safety, (3) modernising infrastructure, and (4) the importance of whānau and connectedness with wider support networks.
More recently, the Waitangi Tribunal accepted a claim lodged by Dr Michelle Levy (Waitangi Tribunal, 2018, WAI 2725, #1.1.1). This claim proposes that the Crown has failed to ensure that “psychology, as an academic discipline and profession, adequately meets the needs and demands of Māori.” (#2.1.1, p.1). In essence, the claim states there is a need to significantly improve the training of psychologists in cultural competence, and to support the development of a Māori psychology profession and workforce.
Leaming and Willis (2016) also claim that treatment programmes within Corrections are failing Māori, and “have struggled to engage with Māori efforts to improve outcomes for their people.” (p.59). They further claim that the primary empirical framework that underpins correctional rehabilitation is fundamentally incompatible with Māori ideas and practices.
While generally increasing numbers of people in prison and the long-standing over-representation of Māori subject to judicial sanction are well-known statistics in the public consciousness, the impact of rehabilitation programmes in general and the role of psychologists in correctional environments is often neglected in conversations about criminal justice. Our lack of visibility functions to hide the positive changes of many individuals who have histories of harm against whānau and communities. Psychologists who work with this population not only operate within strict legislative contexts but also observe ethical principles such as responsible caring, social justice, and dignity to peoples and persons (e.g., protection of victims) which means that much of this work occurs outside of the public gaze. However, perhaps our lack of visibility also allows views like those expressed subsequent to the latest Waitangi Tribunal claim to promulgate unchallenged. We realise that our voice has been largely absent from critical discussion about what could be working for Māori. This is not in the best interests of our Māori clients or the goals of our organisation.
That said, we argue that while we should and can do more to address social justice inequalities and inequities for Māori who have contact with the criminal justice system, we do not accept the assertion that psychology (as an applied clinical profession) is dismissive of and not meeting the needs of Māori clients.
Over the years we have made ongoing efforts to meet the needs of Māori clients in the provision of our services; these efforts were outlined by former Chief Psychologist Nikki Reynolds in her evidence to the Waitangi Tribunal (2017, #A038). This included prior bursaries for Māori students studying clinical psychology, the provision of cultural supervision to psychologists, building in cultural competency development into staff progression requirements, and the development of treatment programmes that emphasise a relationship between te ao Māori and Western psychology concepts (described further, below). These initiatives have occurred alongside a range of efforts within Corrections to develop tikanga-based rehabilitative and reintegration approaches (Campbell, 2016).
Effectiveness of treatment for Māori clients
If the work of psychologists is to work for Māori, our efforts must show evidence of (1) relevance and (2) effectiveness.
The criterion of relevance, in essence, is one of acceptability, or meaningfulness for end-users. Tamatea, Mason, and Ryan (2010) and Campbell (2016) describe a range of initiatives designed for Māori – and invariably with Māori – developed within Corrections’ Psychological Services.
The criterion of effectiveness is one of positive change in a way that is measurable. It is beyond the scope of this piece to detail the content of our rehabilitation programmes. However, it is worth noting that the Department’s culture of evaluating outcomes has provided rich opportunities to closely monitor rehabilitation programmes and facilitate quality decision-making about salient issues like format and dosage (e.g. closed/open, fixed/rolling), content (i.e. target behaviours), process (e.g. high-risk personalities), and participant selection.
Consider the following: The Te Piriti Special Treatment Unit (STU) programme treats men who have sexually offended against children, and was designed to promote a synergistic relationship between te ao Māori and Western (primarily, North American) models of therapy that are empirically known to be effective for reducing sexual re-offending (Nathan, Wilson, & Hillman, 2003). Early in its development period, processes were implemented to understand the cultural needs of each client, to incorporate tikanga practices throughout the STU community life, and to create an environment that supported the application of Māori values to therapeutic learnings. Relationships with local iwi, Māori service providers, and Māori staff supported these processes and assisted therapy staff to practise in a culturally responsive manner. An evaluation of this programme was conducted in 2003 (Nathan, Wilson, & Hillman). Among the 201 men who had participated in the programme, only 5.5% committed another sex offence, compared to 21% who did not participate (figures based on an average 2.4 years post-release, matched with the intervention group on age, conviction history, and ethnicity). As far as sexual recidivism was concerned, the programme was at least as effective for Māori men as it was for non-Māori. Furthermore, Māori participants fared significantly better in this programme than in a similar programme that did not have the same level of emphasis on balancing te ao Māori and Western psychology models. These early findings suggested that the work of the Department has been effective in reducing sexual re-offending for Māori specifically.
The results also echo recent findings that the treatment offered by STU programmes, which are largely attended by participants identifying as Māori (Kilgour & Polaschek, 2012), are year upon year the most effective within the Department of Corrections for reducing re-offending (e.g., Department of Corrections, 2016; 2017a; Johnston, 2018).
Despite these encouraging findings, it is equally, if not more, important to us to know from our clients whether we are delivering services in a way that works for them.
Cultural safety and clients’ perspectives
In a nursing article addressing very similar issues to those raised by Dr Levy’s claim to the Tribunal, Dr Irihapeti Ramsden first wrote of the need for health services to adhere to Kawa Whakaruruhau – Cultural Safety, a concept first formulated at a hui for nursing education leadership in 1988. This was in response to nursing students’ concerns that their cultural identities were not being attended to during training and that they felt ill-equipped to meet the needs of Māori patients. The concept of cultural safety has since formed a part of the New Zealand Psychologists Board practice guidance (New Zealand Psychologists Board, 2009). Importantly, Kawa Whakaruruhau is not determined by a top-down perspective on what is “safe”, “competent”, and “responsive”. In the words of Dr Elaine Papps and Dr Ramsden (1996, p.494):
“It is not the [practitioner] who determines the issue of safety. It is consumers or patients who decide whether they feel safe with the care that has been given. (…) [Cultural safety] assumes that each health care relationship between a professional and a consumer is unique, power-laden, and culturally dyadic.” (emphasis added).
Kawa Whakaruruhau encourages us to recognise the unique perspective that each client has on their cultural identity, and what they and their whānau want from practitioners in the consideration of that identity (cf. Wepa, 2015). It “provides clients with the power to comment on practices and contribute to the achievement of positive health outcomes and experiences” (Banks & Kelly, 2015, p.27). It also encourages practitioners to avoid assumptions that Māori are somewhat homogeneous in beliefs, practices, or in expectations and experiences of psychological treatment.
Therefore, rather than making assumptions about our clients’ experiences, what do our clients actually say about the efforts of psychologists to meet their cultural needs?
Māori client perspectives on the treatment they have received in Psychological Services
Over a number of years we have had the opportunity to work intensively with clients in seven Special Treatment Units (STUs), in which specialist programmes are facilitated by Psychological Services. Six STUs are based in prisons, with one (Tai Aroha) based in the community. These units offer treatment for serious sexual and physical violence offending within a therapeutic environment. Several formal and informal studies have taken place to ascertain the views of our clients on the treatment they have received. Here we describe the findings of five studies, over eight years, which specifically sought the views of Māori clients regarding the relevance and effectiveness of psychological treatment.
In 2010, two informal studies looked at Māori clients’ experiences of programmes where a dynamic relationship operates between te ao Māori and Western psychology approaches (Hallet, 2010; Jervis, 2010). The findings of Hallet (2010), who interviewed four Māori participants, found that clients’ experiences were largely positive. Paramount to this was treatment provided in the context of an environment and therapeutic relationships that fostered attitudes of genuine interest, awareness of cultural differences, warmth, and collaboration. Jervis (2010) also interviewed four Māori participants, finding that clients additionally valued having a Māori practitioner with whom to talk and that this enhanced their learnings from the STU programme. In this latter study, no clients felt there was incompatibility between te ao Māori and the Western psychology aspects of the STU programme.
In 2012, a review of the violence-prevention focused STUs was undertaken (Kilgour & Polaschek, 2012). As part of this, exit interviews were held with 22 men who had completed this nine-month Special Treatment Unit Rehabilitation Programme (STURP). Participants were drawn from four STUs with some being surveyed immediately following treatment and some at around eight months following treatment completion. Eleven (50%) of these men were Māori. Part of the exit interview directly canvassed these men about: (1) how effectively the programme met their cultural needs; (2) what effect the programme had on the client’s pride and identity as a Māori man; and (3) what the programme could do to be more effective in addressing the client’s cultural needs. Other parts of the survey asked questions about how the (mainly) non-Māori facilitators respected and related to programme participants. Universally, Māori and non-Māori participants alike expressed that they felt respected by their facilitators and that respect was actively demonstrated in the context of genuine personal interactions. The willingness of facilitators to provide attention, actively listen and respond in a respectful manner was particularly important to the men. Additionally, Māori participants consistently valued the programme. Overall, men stated that they believed the programme met their cultural needs; however a few, mainly non-Māori men, had difficulties with the cultural content, expressing a negative view of the Māori content in the programme or finding that it increased the complexity of the material to be learned. Suggestions for improvement included a need for a greater Pacific influence. One client of the 11 indicated preference for the programme to be run by mainly Māori staff in a Māori way (these matters are addressed, below). Others saw the STURP as a programme that is useful for people of all cultural backgrounds.
The Tai Aroha programme is a community-based residential violence prevention programme based on bicultural principles. The inclusion of tikanga-informed practices and support has marked this programme out as a successful long-running programme that has enjoyed support from Tainui. Tai Aroha has long held a particular focus on employing staff who have the ability to support the tikanga foundation of the programme. Programme participants are routinely interviewed prior to completion and exit from the whare. Sixty-four participants over seven years have offered insights into their experience and opinions of psychological practices in terms of outcomes important to them, notably cultural responsive practices and overall emotional wellbeing:
Most of the men (N = 64) who have to date responded to the interviews identified as Māori or Pasifika. With regards to how well the programme was a good “fit” for their cultural needs, the majority reported positive experiences (i.e., good fit). Some comments to this effect included:
“I never knew any tikanga. I learnt my iwi, waka, wairua, spirits, te para para, waiata, karakia. It has all been helpful.”
“Not too bad. Learnt things here I can take back to my kids.”
“Very well. Encouraged connection to identity. Learnt a mihi and to whai korero. Tikanga is uplifting - sense of pride - balanced - more spiritual.”
Some views were less enthusiastic, reflecting a significant range in people’s experiences:
“Before I came it [culture] was part of the programme, but since I've been here there hasn't been anything on it. My cultural needs haven't been met.”
Others commented that they were not ready to participate in cultural processes at the time of the programme, serving as a reminder that addressing the needs of Māori does not always equate with participating in traditional practices.
A theme of diversity in clients’ views is repeated throughout this series of studies. Some clients value te ao Māori as integral to their identity, and wish for this to be incorporated within the treatment context, while some prefer not to participate in traditional practices. The recent revision to the STURP (violence prevention) programme aimed to address this diversity, with the establishment of cultural development plans. These are client-centred personalised plans for cultural development which take into account clients’ current stage of cultural identification. With the support of a therapist, clients co-create the plan to identify their needs (e.g., developing a te ao Māori perspective on a particular psychological concept), and are supported to access resources to assist in the outworking of the plan. These plans have also been implemented in the Tai Aroha programme. The STURP revision also incorporates the creation of a pūrākau (story) to give clients the opportunity to share the narrative of their life history with their therapy group and therapists. The natural environment of the unit aims to further support cultural connection and expression through client-created paintings and sculpture.
In January 2018, focus groups were held with Māori men participating in the STURP programme, to understand the extent to which cultural aspects of the programme were beneficial or not to participants (Oliver, 2018). Clients spoke of valuing the autonomy offered to them through the development of their cultural plan. Knowing that they could define what was culturally important to them helped empower them to take a personal investment in a prosocial cultural identity. Participants in this study expressed the importance of having different cultural perspectives available to them by non-Māori therapists and peers, and importantly a genuine approach by staff to considering culture. No clients were reported to identify detrimental impacts upon their cultural identity.
Taken together these findings offer positive support for the responsiveness of psychology to Māori, and that Māori clients often have the opportunity to have their cultural needs met in an understanding and therapeutic environment. The experiences of clients here, held in contrast against some of the more critical rhetoric, are reminiscent of earlier New Zealand research. For example, research has produced findings indicating that Māori clients value the therapeutic services provided by non-Māori practitioners despite an increasing deficit-focus due to the lack of a Māori health workforce (Awatere-Walker, 2015), and that clinicians are able to satisfactorily consider the spiritual beliefs of their Māori and non-Māori clients. Academic rhetoric, that such beliefs are ignored by practitioners, may be little more than that - rhetoric (Castell, 2013).
We do not suggest that the evidence presented here is comprehensive and we do not yet have a full picture of what psychology’s “success” with Māori would look like from a whole-of-community perspective. What it does is present a snapshot across both formal and informal attempts to understand whether we can be considered to be working effectively with Māori clients. These are the views of men we have had the opportunity to work with; it does not necessarily reflect the views of those who have not had this opportunity. We do not know how many, through concern that their cultural identity may be marginalised during their work with psychologists, have chosen to go elsewhere for help. Further, we cannot ignore the clients who do not feel the same way as the larger proportion of their peers, for example the clients who may prefer treatment from a primarily te ao Māori perspective (which is offered through a range of tikanga programmes in Corrections), or those who prefer not to address culture as part of their work with psychologists.
Nevertheless, the instruction from previous New Zealand research seems applicable here: “Strive to be aware, to understand, and to take collaborative action” (Castell, 2013, p.203); work to reflect on and dwell with discomfort and difference; and “see and hear, beyond ethnicity, the human [we] are working with.” (Awatere-Walker, 2015, p.ii). From the evidence we have presented, similar themes are repeated. In particular our clients’ feedback about what allowed them to benefit from the treatment they received: awareness, genuineness and respect; the opportunity to be heard and listened to; and the opportunity for te ao Māori to exist in a dynamic relationship with psychological models.
Can more be done? Absolutely. We wholeheartedly support the continual development and refinement of our work with Māori clients, including building partnerships that strengthen this further. We also support the practice of asking what clients need and have received, rather than relying on assumptions. Finally, we support the resourcing of these efforts. Despite the promulgation of oft-unqualified views suggesting that psychologists are dismissive of Māori needs, we hope to have demonstrated through client feedback that we have made many successful efforts to attend to our clients’ cultural needs, and continue to do so.
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