Concepts of Recovery in Mental Health: Maori Population Analysis

This report provides a comprehensive literature review on mental health issues within the Maori population of New Zealand. It explores the historical and socio-political influences on recovery, including the impact of colonization and cultural identity. The paper defines recovery in mental health, contrasting clinical and personal perspectives, and examines key concepts such as social involvement, empowerment, hope, identity, and meaning. It analyzes philosophical and theoretical frameworks, including Te Whare Tapa Wha, and discusses recovery approaches in practice. The report also addresses the implications, strengths, and gaps in the research, offering recommendations for future practice and research. It highlights the importance of Whanau ora and culturally sensitive approaches to improve mental health outcomes within the Maori community.

Concepts of
Recovery in Mental Health
Maori Population
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Table of Contents
1. Introduction..............................................................................................................................3
2. Background Context.................................................................................................................3
2.1 Definitions of Recovery in Mental Health.............................................................................3
2.2 Historical and Socio-political influence to Recovery in New Zealand.................................5
2.3 Current Trends about Recovery.............................................................................................7
3. Philosophical and theoretical perspectives of recovery in context of Maori Population with
Mental health issue..........................................................................................................................8
Health Recovery Frameworks in New Zealand...........................................................................9
Social involvement....................................................................................................................11
Empowerment............................................................................................................................11
Hope...........................................................................................................................................12
Identity.......................................................................................................................................13
Meaning.....................................................................................................................................14
4. Recovery concepts and approaches to practice in context of Maori Population with Mental
health issue.....................................................................................................................................14
5. Implications and strengths and gaps in the research..............................................................15
6. Conclusion and Recommendations........................................................................................16
References......................................................................................................................................17
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1. Introduction
This paper presents the literature review regarding the mental health issues among Maori
population, a community based in New Zealand. New Zealand is among the countries that is
facing the mental health issues since decades. This literature review will provide some useful
insights about the past and present mental health status of people along with the government
initiatives and programs that are utilized for alleviating the mental healthiness issues among the
population of Maori. The origin of these people can be traced back to 1000 years back from the
Polynesian homeland of Hawaiki. Maori today constitute around 14% of the New Zealand’s
population. The identity of New Zealand is much represented by Maori culture (Soosay & Kydd,
2016).
2. Background Context
2.1 Definitions of Recovery in Mental Health
The term “recovery” can be referred to as coming back to the normal state of strength, mind and
health. In perspective of mental health, however, ‘recovery’ means returning back to the normal
state of health after being in mentally ill condition (Corlett & Miles, 2010; Mental Health, 2018).
Recovery has different meanings for different people, for some recovery indicates the process
skill and relationship development and realization of goal or leading a life without any mental
problem. Recovery from any form of mental disorder can be referred to as the process of change
through which an individual can improve his/her wellness and health, live a life that is self-
directed along with having zeal to achieve their full potential. Jacob (2015) in his study stated
that the notion of recovery in mental cannot be defined with help of a single definition but, there
are some guiding principles that focus on a strong belief and hope that there is a possibility that
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people with some of form of mental health problem can also live a healthy and significant life
even after suffering a mental problem (Jacob, 2015).
Some other perspectives regarding recovery have also been highlighted by Ramon and Ranouf
(2007) in their study, they indicated that recovery for public with a mental health issue is about
control of one’s own life instead of being in an indefinable state of functioning (Ramon, Healy,
& Renouf, 2007). The above definition by authors does not emphasize on the complete
resolution of the mental health problem but, it focuses on resilience and gaining a control over
life among the people who are facing a mental illness issue or an emotional distress. This term
remains constantly in use in the context of mental health for people, whose better health
conditions are expected after suffering from mental illnesses (Barsky & West, 2007; Bressington,
Stewart, Beer, & MacInnes, 2011). The meaning of recovery in context of mental health is
generally relying on personal recovery of the mentally ill patient (Mental Health Foundation,
2019).
Recovery takes place within an individual facing mental illness when they get back to their
normal health conditions. It is considered as a process or a way of life as well as the approach of
an individual towards health-related challenges existing in the life (Copeland, 2017). They prefer
to satisfy their life requirements along with rectifying the challenges related to disability as well
as to reestablishing their new and integrated lifestyle (Cleary & Dowling, 2009). They make
themselves able to live and work within the society to deliver their maximum potential in
collaboration with the society (Crane-Ross, Lutz, & Roth, 2006). Recovery refers to an in-depth
personal procedure of altering the approaches, goals and roles of the individual in their life and
in society (Roychowdhury, 2011). It is considered as a method of living a fulfilling, optimistic,
and contributory life despite number of hindrances occurring due to illness. It involves the
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creation of innovative purpose in the life of individuals after suffering the disastrous effects of
mental illness (Mental Health Commission, 2011, p. 5). It is considered as an interactional
process that occurs between the environment and the individual, which includes the self-
management of the psychiatric disorder along with reclamation, and maintenance of the positive
sense in the life despite the challenges of psychiatric disabilities (Cleary & Dowling, 2009).
2.2 Historical and Socio-political influence to Recovery in New Zealand
The recovery in mental health and addiction are considered as one and the same thing. In the
process of recovery, people get control of their life, which is previously restricted due to their
conditions or by the responses of the people towards it. The mental health conditions of the
people during recovery stage from addictions are considered to be emphasizing more on
overcoming their addiction instead of focusing on the perceptions of others towards it (Adshead,
2012). Contrary to it, the people suffering specifically through some kind of mental disorders
focus at least partially on overcoming the responses of others through advocating on recovery
and harm reduction in addictions. The reduction in the harm to the physical, mental and
psychological condition of an individual is considered as essential for the process of recovery.
Whanau ora have emerged as a concept in a number of documentations as the aim of the health
policy of Maori and for their families to provide them with the maximum possible happiness and
health (Amering & Schmolke, 2009). The new programs introduced by the government for the
purpose of providing effective services to the population of whanau, possess an aim to enhance
their efficiencies (Barsky & West, 2007). The recovery exists from western individualistic
perspectives while whanau ora are based on collective perspective. Though whanao ora seems to
be closely related to the elements of recovery with its emphasis on potencies and improve its
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functions in close association with whanau as well as offering them with wide variety of
incorporated services (Mental Health Commission, 2011). Whanau ora could have perceived as
the recovery processes for the community of Maori. In general, “Tewhare tapa whā” model
associated with mental health issues give details about the concept of Maori community about
health to the communities associated with them.
Gawith and Abram (2007) have conducted a study to explore various major developments
formerly within social policies, governmental changes as well as provision of finances for mental
healthcare services in New Zealand, specifically after the Mason Report. The increasing
consumer contribution in the after effects of this report at numerous levels of mental health
service system could be inspected with emphasizing more on acceptance of the recovery as guide
for the mental health policies of the country. The consumers and care providers contribute a lot
to the strategy, policies and service expansion countrywide as well as locally. The prospects for
support and assistance provisions have increased for various people facing various types of
mental health issues. Although, the government policies and systems are designed in such a
manner to support the empowerment of the consumer and in their recovery procedures, various
efforts are still required prior to the complete paradigm shift as well as greater consumer
participation could be attained for people living with various kinds of mental health issues
existing in the New Zealand. The mentally ill population and their family members exercise their
say presuming the increasing critical roles in the preparation of policies as well as in designing
recovery services as well as delivery. This control helps to outline the changes in proficient
thinking as well as practices regarding mental healthcare services. Presently, it is usually
acceptable that mentally ill people possess valid consideration regarding their cure as well as
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care provided to them or received by them and the services as well as procedures that deliver
care (Gawith & Abrams, 2007).
The comprehensive survey conducted by “Te Rau Hinengaro” national health survey of New
Zealand, it has been found that more than half population of Maori community experience
mental illnesses. The research study revealed that the main reason behind high rate of mental
illness were poverty, lack of access to health facilities, detachment from cultural identity, racial
discrimination and various other environmental factors, all of which contributed to poor health
outcomes among Maori community (O'Hagan, Reynolds, & Smith, 2012).
2.3 Current Trends about Recovery
According to Deegan (2007), recovery refers to the internally unique and transformative
pathway, wherein, past is lost with self-transformation. The recovery process is considered as
common acceptance between the mentally ill people, clinicians, and their families or whanau and
many more. The research studies related to the concept of recovery is considered as an
autonomous procedure of treatment with support of friends and family or whanau. All these
people help in fostering and empowering consumers so that they could take responsibilities,
make choices, get engaged in life opportunities, develop meaningful relationships as well as
satisfying their livelihood (Deegan, 2007). The role of recovery-based services is to provide
assurance that all these satisfying aspects are enhanced for the purpose of individuals suffering
from mental illness.
A pioneering approach had been proposed by Randal et al. (2009) which supports recovery of
individuals, which has been experienced by the unrelenting signs of psychosis and various other
tremendous health conditions. The “Recovery Model” that had been developed by the expert and
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experienced mental health professionals, provides shared understanding about the conditions of
humans in sociological, psychological, cultural as well as religious developmental context,
wherein, flexibility and vulnerabilities support the development of the individuals. It is
understandable for the service clients, medical experts to discuss the communal recognition of
the outlines that create various disgraceful as well as abating functions. This model has been
based on the fact that humans remain on their unique kind of recovery pathway through which,
they ultimately achieve their normal life experiences from mental illness, decrease of stigma and
intolerance effects. In this way, this model is considered as a powerful instrument to encourage
hope and to induce elements to support the recovery of the mentally ill people (Randal, et al.,
2009).
3. Philosophical and theoretical perspectives of recovery in context of Maori
Population with Mental health issue
The elements of recovery are considered as significant and important factors responsible for
supporting recovery among mentally ill population of Maori. These factors include mental health
practitioners and clinicians encouraging and motivating the sufferers that hope, belief and
optimism is possible. There are certain restrictions as well as opportunities associated with the
execution of recovery prospects of social involvement, hope, empowerment and identity in the
external environment (Drennan & Alred, 2013).
In this context, the recovery model is considered as an individual advancement towards mental
health care. The basis of this model is that recovery of mental health conditions of individual is
possible and patient directed approach is considered as most effective recovery. As per the
“Substance Abuse and Mental Health Services Administration (SAMHSA)”, there are some
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requirements that could support the process of recovery among Maori population. SAMHSA
considers few guiding principles, on which, recovery treatment is based and it should incorporate
individualized approach, empowerment, hope, respect and social involvement and providing
them with proper identity to get adopted within the society (SAMHSA, 2019).
Health Recovery Frameworks in New Zealand
One of the health models introduced by Mason Durei in the year 1985 was the Te Whare Tapa
Wha which means - The four-sided house. This model proposed that there are four interacting
dimensions. A balance between these dimensions ensures holistic mental health of an individual.
According to this model, no single dimension of model is important in comparison to other, a
balance need to be ensured among all the four dimensions (Durie, 1985). The “Te Whare Tapa
Wha” was utilized among Maoris as a hypothetical structure that was used for the analysis of
smoking behavior among the Maoris (Glover, 2015). This particular model has been adopted
widely in Aotearoa New Zealand and the same is evident in the health practices and policies
(Ministry of Heallh, 2002). The Te Whare Tapa Wha model application for smoking behavior
analysis indicated that there was a need of a more holistic approach for behavior analysis. There
are a variety of other models that have been implemented for the mental health of Maori people
but, Te Whare Tapa Wha has achieved a special status of a recognized paradigm (Ministry of
Heallh, 2012; Kuhn, 1996). Love (2004) in his study indicated that one of the important features
of Te Whare Tapa Wha is that it requires all the four cornerstones to work together so as to
achieve a balance and ensure a good health (Love, 2004).
O'Hagan, Reynolds, and Smith (2012) in their study indicate that “Te Whare Tapa Wha” model
is the welfare model that is used for recovery of people who are facing a mental issue. This
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model focuses on the physical health, religious, mental health along with the families’ healthcare
facilities.
Another major conceptual framework that is used in the personal recovery of mental health is the
CHIME Framework. This particular recovery model has a major aim of helping the people with
certain types of mental illness along with helping such people to look beyond their existence and
survival. CHIME is a conceptual framework for individual recovery and it involves
Connectedness as the main approach. The CHIME framework for recovery from mental illness
encourages the people with mental illness to set up their new goals and objectives along with
doing things that can add value to their lives. The acronym CHIME stands for – “Connectedness,
hope, identity, meaning, and empowerment.” Shankset al (2013) in their study focused on the
fact that the orientation of personal recovery is central to the countries such as New Zealand,
Australia, US and England.
Brijnath (2015) in his study focused on all the five dimensions of CHIME framework. The
Connectedness refers to the relation an individual has with its society and community members.
Hope refers to a belief that a mentally ill person has regarding their betterment. Identity is about
transformation of a sense of identity so as to identify a sense to life. Empowerment in CHIME
mental recovery framework is about the feeling of being a powerful member of the world
(Brijnath, 2015). Slade, Leamy, Bacon, Janosik, and Boutillier (2015) in their study provided
useful insights related to CHIME framework. The authors focused on the limitations associated
with CHIME model. The authors stated that there is a limited work on CHIME model application
and hence, there is a lack of themes related to recovery. The authors have also indicated CHIME
model is applied more on the white population. The authors called this phenomenon as the
monoculture view culture.
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Social involvement
Social involvement incorporates social elements associated with the recovery of sufferers
specifically for the inclusion of mentally ill population of Maori in the society, identifying the
impact of social systems for the sufferers as well as their participation within the community.
The social involvement is related to the social roles and social inclusion within the society as
well as relationships. It has been noticed that the Maori population face various types of
differences in the society due to their mental illness and for their criminal records (Mann, Matias,
& Allen, 2014). Due to this reason, various barriers are being faced by them and such social
obstacles make it difficult for them to receive the support from their families, known, medical
practitioners as well as from the society as they have limited access to the pathways towards
social involvement. Mentally ill people from Maori community require access to the effective
social roles; education, housing, and social involvement but face various barriers in being
involved within the society. According to Mezeya, Kavumab, Turtona, Demetriou, and Wright
(2010), the ‘Recovery Approach’ is considered as the guide for the mental health service. The
stigma associated with their being offenders and seriously ill mentally, hold back their recovery
and hinders their independent living within the community. Despite number of hindrances to
societal involvement for the people of Maori going through mental illness, clinicians identify
social involvement as an essential element for their recovery.
Empowerment
‘Empowerment’ refers to the intensification of responsibilities, competences, and imagination of
the individuals or group or members. Copeland (2017) had developed effective materials and
instrument for education which offers empowering opportunities for the purpose of achieving
health and wellness to the mentally ill Maori community within the mental health care system
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(Copeland, 2017). As identified, majority of Maori population live in poor conditions and face
various types of stresses and restrictions due to their mental illness. Corrigan (2006) considered
empowerment, autonomy and self-efficiency as the necessary components of recovery
procedures. It results in the supposition that empowerment could have assessable influence on
the process of recovery. The measurements applicable to recovery are hope, empowerment,
social networks, satisfaction as well as autonomy, which are considered as salient dimensions of
recovery (Amering & Schmolke, 2009). The empowerment is also associated with the quality of
life and the awareness regarding handling of mental health care system. Also, there is an
effective relationship between recovery and service empowerment, social support and inclusion.
The encouragement of empowerment is considered as significant in the recovery-based work.
Crane-Ross, Lutz and Roth (2006) had studied about the relationship between recovery and
service empowerment. The subjective assessment of empowerment exerts huge influence on the
measures associated with recovery. The successful health management process in primary care
depends on the ability of the mentally ill population of Maori community to respond to their
mental health conditions. As per the health professionals of New Zealand, Maori are hereditarily
susceptible to psychotic health conditions and various other serious mental health conditions
(Johnstone & Read, 2000).
Hope
Mental health services can prove to be beneficial for the recovery of mentally ill people from
Maori community if they achieve success in enhancing control, choice and hope but it is
considered as highly destructive if it destabilizes self-determination as well as express
hopelessness and pessimism. Various efforts to develop the concepts of recovery make various
distinctions between internal as well as external aspects. Jacobson and Greenley (2001) believe
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hope as well as health related factors from the point of view of identity and sense of worth
beyond illness considering the control over individual life. The elements of recovery associated
with person centered approach include hope, autonomy, as well as consciousness (Jacobson &
Greenley, 2001). According to Bradstreet, shared elements of recovery comprise hope, capacity
to change, purpose, control, active participation, environment, creative risk-taking and optimistic
as well as realistic approach. There are various available measurements related to recovery such
as optimism and hope; excellence of life and empowerment; knowledge to deal with support
schemes; social systems and satisfaction and independence (Jacobson & Greenley, 2001). The
recovery is considered as a process that implies hopeful vision, subjective comfort, goal, point of
reference and empowerment. It is essential to create hopeful environment for people with
psychiatric for the purpose of creating such a situation that could offer potential for further
progress. It is also essential to develop spirit of hope among mental health care teams that they
could assist mentally ill population of Maori in their recovery by provided them with required
development opportunities. To achieve the purpose, the people with psychiatric issues should be
asked about their requirements for the purpose of growth. The actual transmission and
experiencing hope in life are considered as complicated aspects in relation to the recovery
processes among mentally ill people (Deegan, 2007).
Identity
Drennan and Alred (2013) discussed about the restrictions and opportunities related to the
execution of recovery approach, wherein, connectedness, hope, identity, meaning and
empowerment have been emphasized. In simple words, identity means to regain positive sense of
self by overcoming the stigma and it includes redevelopment of self-identity in the society.
Similarly, in the research study conducted by (O'Hagan, Reynolds, & Smith, 2012). It has been
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stated that poverty, lack of access to health facilities, detachment from cultural identity, racial
discrimination and various other environmental factors have been the major reasons behind
prevalence of mental illness among Maori population. As per SAMHSA, recovery treatment
should incorporate individualized approach, empowerment, hope, respect and social involvement
and providing them with proper identity to get adopted within the society (SAMHSA, 2019).
Jacobson & Greenley (2001) also believed that individual life is controlled from the point of
view of identity and sense of worth beyond illness and other health related factors.
Meaning
The conception of personal recovery of the mentally ill suggests that the role of individuals,
society and the clinicians is highly significant in the process of recovery of such people. It also
implies that the need for self-direction and variety of services could facilitate their recovery as
early as possible to the meaningful life and purpose (Mental Health Commission, 2011, p. 6). As
stated by Deegan (2002), autonomous procedure of treatment of mentally ill people, with support
of friends and family or whanau is possible if they support them in taking several
responsibilities, making choices, getting engaged in life opportunities, developing meaningful
relationships as well as satisfying their livelihood (Deegan, 2007).
4. Recovery concepts and approaches to practice in context of Maori
Population with Mental health issue
Taking into consideration, the analysis of process of recovery in the background of mental health
and illness among people, various implications could be suggested for the purpose of supporting
the process of recovery among mentally ill people from Maori community. During planning,
medical services are required to be responsive and unique requirements of the Maori population
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as well as associated environment create huge challenges for the purpose of implementation of
evident recovery process. Drennan and Alred (2013) emphasize that safe and sound assimilation
of the elements of recovery require the medical service providers to be highly innovative for the
purpose of supporting the process of recovery within the limitations of preventive environment
and to fasten the process (Adshead, 2012). The people with mentally ill health conditions from
Maori community have the probabilities to positively become accustomed, wherein; pro-social
behaviors might be well-read and trusted for the purpose of developing relationships. The
clinicians and medical health practitioners can support them to develop their efficiencies to be
engaged within the society and to be accountable for their individual recovery. With the highly
restrictive external conditions, the sufferers become able to take decisions, responsibilities as
well as to take decisions for them.
5. Implications and strengths and gaps in the research
The findings presented in this paper reinforce the need for ensuring the better outcomes from the
perspectives of mental health. The well-being budget of New Zealand does offers new hopes to
Maori people but, based on the analysis there are a number of changes that are needed among the
Maori people community. Firstly, there is a need to change the belief system of Maori people
that people with certain mental disorders are so unwell that they need to be hospitalized in
hospitals. A holistic approach needs to be adopted that can help in acknowledging the various
mental disorders that have been discussed in the above paper. The above literature review has
provided both the past and present data regarding the mental disorders that are widely prevalent
among the Maori along with the major causes that are leading to such outcomes. The findings of
this study can be used by the New Zealand authorities for understanding the mental health issues
15

in Maori in detail along with implementing the issue specific mental health improvement
approach in the region. Maori people in New Zealand constitute 744,800 people including
363,800 males and 381,000 females (Stats NZ, 2018). These people need to be protected so that
an old age community can be saved. This paper provides a huge assistance in the recovery
process of Maori. The discussion below will focus on concluding the research along with
providing certain recommendations that can help in recovery of Maori (Mental Health
Foundation of New Zealand, 2019).Through relevant literature, it has been realized that most of
the research studies have discussed about the conditions of the mentally ill people and their
sufferings but none made sure if the reasons behind the such conditions of mentally ill people is
same or different (Mental Health Foundation of New Zealand, 2008). The gaps associated with
literature are the lack of identification of reasons behind the mental health conditions of such
people and the efforts that could be made by the government to improve the conditions of
mentally ill people. However, there are a number of strengths of relevant research studies, which
include explanation about the general health conditions and expectations of mentally ill people
from the society, factors responsible for their better health conditions and the ways that could be
adopted by the mental health practitioners for the betterment of the mentally ill people. All these
approaches and strategies could be applied in the context of Maori population, who are suffering
from various mentally ill health conditions.
6. Conclusion and Recommendations
The above paper has focused on the challenge of mental health among Maori people in New
Zealand. The Maori people have issues ranging from depression to suicide. There are various
causes that led to the mental healthcare issues among the people. The New Zealand government
16

has the potential and assets that will make possible the procedure of recovery of Maori people.
CHIME is one of the potential mental recovery frameworks that can be utilized for improving
the mental health of Maori people. The CHIME framework focuses on the dimensions that
holistically focus on the mental recovery of the people. In this context, the focus should be on
the five dimensions - “Connectedness, Hope, Identity, Meaning and empowerment.” The
connectedness among Maori people can be improved by encouraging Maori people to help and
support each other in the case of mental illness. Further, a belief in recovery process of people
with mental illness requires being aroused. The Maori community with mental illness should be
empowered to find a purposeful life by focusing on education and employment. In addition to it,
efforts should also be made to provide them with easy access to health facilities. Their
recognition in the society should be emphasized upon by increasing their contribution to the
society and to regain cultural identity within the society. There should be strict legal provisions
against racial discrimination in the society as it affects various segments of society and keep
them detached to each other.
The literature review discussed above provides a direction to implement the policies and
strategies that can changes the lives and mental health status of Maoris. Lastly, the awareness
and education regarding the mental health disorders among the Maori population will also help
in alleviating the mental health disorders in the region.
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