Decolonising the medical curriculum: psychiatry faces particular challenges.

Colonial thinking runs deep in psychiatry. Recent anti-racist statements from the APA and RCPsych are to be welcomed. However, we argue that if it is to really tackle deep-seated racism and decolonise its curriculum, the discipline will need to critically interrogate the origins of some of its fundamental assumptions, values and priorities. This will not be an easy task. By its very nature, the quest to decolonise is fraught with contradictions and difficulties. However, we make the case that this moment presents an opportunity for psychiatry to engage positively with other forms of critical reflection on structures of power/knowledge in the field of mental health. We propose a number of paths along which progress might be made.

Mahi a Atua: A Maori approach to mental health.

Maori are the indigenous people of Aotearoa New Zealand. European colonisation had a devastating effect on their communities and their way of life. While there is some evidence of a renaissance of Maori culture in recent years, like other indigenous people across the world, they continue to be massively overrepresented in their country's figures for poor mental and physical health. In this paper, we briefly review the literature on the Movement for Global Mental Health and review the case that has been made for the use of indigenous psychologies in place of approaches based on Western psychiatry and psychology. We present two case histories where an intervention based on an indigenous Maori approach to negotiating emotional conflicts and dealing with mental health problems was used. This approach, called Mahi a Atua, was developed by two of the authors over a number of years. We conclude that indigenous approaches to mental health offer not just an adjunct to, but a real alternative to, the interventions of Western psychiatry. They provide a framework through which individuals and families can negotiate their journeys through mental health crises and difficulties. However, such approaches can also work on a socio-cultural level to promote a positive identity for indigenous communities by celebrating the power of indigenous deities, narratives, and healing practices that were marginalised and suppressed by the forces of colonisation.

Factors that facilitate and constrain the utilization of a Kaupapa Maori therapeutic approach with Mahi-a-Atua.

OBJECTIVES: To further progress Kaupapa Maori (Maori focused) approaches within mental health services this study explored the experiences of Maori clinicians from a dedicated Maori mental health service in New Zealand, with a focus on a specific Kaupapa Maori therapeutic approach, Mahi-a-Atua. METHODS: A qualitative approach was used to ascertain factors that facilitate and obstruct the utilization of Mahi-a-Atua. In a focus group hui (Maori meeting process), eight Maori clinicians discussed their experiences. RESULTS: Facilitation of Mahi-a-Atua by Maori clinicians occurred through interconnectedness of a number of factors including cultural identity, relationships, wairuatanga (spirituality), kaitiakitanga (guardianship), validation of the model and the ability to co-work and engage in meaningful wananga (learning) around the intervention. The extent to which clinicians used the model depended on their own perceived knowledge and confidence and how best able to integrate both cultural and clinical knowledge. Other constraining factors pertained to inadequate prior training, limited workforce development training and lack of adequate resourcing for specialized services. CONCLUSIONS: This research highlights the need for Maori focused specialized training that utilizes co-working within sessions and ongoing wananga.