Mahi a Atua: A Māori approach to mental health

Mother nature: Applicability to contemporary attachment styles

OBJECTIVES

Explore humanity's shifting attachment to the natural world using established attachment theories as a framework.

METHODS

Investigate the analogy between human-nature connection and caregiver-child attachment styles. Draw on indigenous case studies, sociology and anthropology to highlight contemporary repercussions of this 'detachment'.

RESULTS

Factors such as rapid population growth and urbanisation have disrupted the secure attachment with nature, which is evidenced in ancient egalitarian societies. These factors can be mapped onto contemporary attachment domains.

CONCLUSIONS

There is an urgent need to re-establish a secure attachment to nature. This may be a pivotal strategy in addressing both mental health and environmental challenges, particularly in the context of the escalating climate crisis.

Indigenous approaches to perinatal mental health: a systematic review with critical interpretive synthesis

Indigenous mothers and birthing parents experience significant inequities during the perinatal period, with mental health distress causing adverse outcomes for mothers/birthing parents and their infants. Limited literature is available to inform our understanding of solutions to these issues, with research primarily focusing on inequities. Our aim was to conduct a systematic review of Indigenous approaches to treatment of perinatal mental health illness. Following the PRISMA guidelines for systematic literature reviews, an electronic search of CINAHL, Medline, PubMed, Embase, APA PsycInfo, OVID Nursing, Scopus, Web of Science, and Google Scholar databases was conducted in January and February 2022 and repeated in June 2022. Twenty-seven studies were included in the final review. A critical interpretive synthesis informed our approach to the systematic review. The work of (Yamane and Helm J Prev 43:167-190, 2022) was drawn upon to differentiate studies and place within a cultural continuum framework. Across the 27 studies, the majority of participants were healthcare workers and other staff. Mothers, birthing parents, and their families were represented in small numbers. Outcomes of interest included a reduction in symptoms, a reduction in high-risk behaviours, and parental engagement/attachment of mothers/birthing parents with their babies. Interventions infrequently reported significant reductions in mental health symptoms, and many included studies focused on qualitative assessments of intervention acceptability or utility. Many studies focused on describing approaches to perinatal mental health distress or considered the perspectives and priorities of families and healthcare workers. More research and evaluation of Indigenous interventions for perinatal mental health illness is required. Future research should be designed to privilege the voices, perspectives, and experiences of Indigenous mothers, birthing parents, and their families. Researchers should ensure that any future studies should arise from the priorities of the Indigenous population being studied and be Indigenous-led and designed.

Te Maramataka-An Indigenous System of Attuning with the Environment, and Its Role in Modern Health and Well-Being

The connection between the natural environment and human health is well documented in Indigenous narratives. The maramataka-a Māori system of observing the relationships between signs, rhythms, and cycles in the environment-is underpinned by generations of Indigenous knowledge, observation, and experimentation. The maramataka enabled Māori and our Pacific relatives to attune with the movements of the environment and ensure activities essential for survival and well-being were conducted at the optimal times. A recent revival of the maramataka in various communities in New Zealand is providing uniquely Indigenous ways to 'reconnect' people, and their health, with the natural environment. In a world where people have become increasingly disconnected from the natural environment, the maramataka offers an alternative to dominant perspectives of health. It also provides a mechanism to enhance the many facets of health through an understanding of the human-ecosystem relationship in a uniquely Indigenous way. This conceptual paper (i) highlights a uniquely Indigenous way of understanding the environment (the maramataka) and its connection to health, (ii) discusses the connections between the maramataka and scientific research on health and the environment, and (iii) introduces current and potential applications of the maramataka in improving health and well-being.

Still in the shadows: a national study of acute mental health unit location across New Zealand hospitals

BACKGROUND

This study aimed to explore the location of acute mental health inpatient units in general hospitals by mapping their location relative to hospital facilities and community facilities and to compare their proximity to hospital facilities with that of general medical acute units.

METHODS

We obtained Google maps and hospital site maps for all New Zealand public hospitals. Geographic data were analysed and mental health units' locations in relation to hospital facilities and public amenities were mapped. Radar plots were constructed comparing acute medical and mental health units' locations in relation to hospital facilities.

RESULTS

Twenty-two mental health units were identified. They were located predominantly at the periphery of hospital campuses, but also at a distance from community facilities. Compared to acute medical units, mental health units were almost universally located further from shared hospital facilities - with distances approximately three times further to reach the main hospital entrance (2.7 times distance), the nearest public café (3.4 times), the emergency department (2.4 times), and medical imaging (3.3 times).

CONCLUSION

Despite the reforms of the 20th Century, mental health units still appear to occupy a liminal space; neither fully integrated into the hospital, nor part of the community. The findings warrant further investigation to understand the impact of these structural factors on parity of health care provision between mental and physical health care and the ability of mental health care services to support recovery.

Conceptualizing a New System of Care in Hawai'i for Native Hawaiians and Substance Use

Native Hawaiians of all age groups tend to show a higher prevalence of substance use than other ethnic groups in the state. Research shows that this inequitable health status results from several complex and interconnected social determinants of health, including historical trauma, discrimination, and lifestyle changes. Before European contact, Native Hawaiians understood that balanced nutrition, physical activity, social relationships, and spirituality were fundamental to maintaining optimal health. Western influences triggered an imbalance in Native Hawaiian society, shifting the paradigm of Native Hawaiian family systems. Historical and cultural trauma affect multiple generations and are linked to Native Hawaiian health disparities. Cultural trauma is defined as "the loss of identity and meaning that negatively affects group consciousness. It marks and changes them in fundamental and irreversible ways, often resulting in the loss of language, lifestyles, and values." The remedy for cultural trauma is cultural reclamation. Historical trauma is defined as psychosocial trauma experienced by Indigenous groups as a result of colonization, war, genocide, or cultural, social, and political subjugation. These historical and cultural aspects have impacted and reached across generations of Native Hawaiians. The outcomes of these traumas are reflected in higher rates of health disparities, including mental health and addiction, which have affected the social determinants of health. Current access to treatment and recovery is limited for Native Hawaiian residents with substance use problems. This article will look at a system of care that would reduce silos and incorporate cultural aspects to improve outcomes for Native Hawaiians receiving services. This article will also introduce an 'āina- (land-) based model for creating healthy, thriving Native Hawaiian individuals, 'ohana (family), communities, and care systems.

In search of mindfulness: a review and reconsideration of cultural dynamics from a cognitive perspective

We provide a critical review of mindfulness research, focusing on three core areas and questions. First, a meta-review and bibliometric analysis on mindfulness research trends identified a large number of meta-analyses published in the last 20 years, which tend to show positive effects on average, despite continuing questions on research quality, unclear pathways and uncertainty about the efficacy of individual practice components. Second, we briefly review current conceptualizations of mindfulness as both a practice and a trait (individual difference variable) and how these interpretations may align with the diverse Buddhist philosophical roots. We examine the multidimensionality of mindfulness within and across cultural contexts, which points to conflicts between bottom-up (functionalist) and top-down (culturally relativist meaning-system) interpretations. In order to reconcile these interpretations, we introduce a predictive coding approach which allows integrating bottom-up biological and individual difference dynamics with top-down normative and cultural influences. Finally, we apply these ideas to two examples of how mindfulness components might be present in different cultural practices: (a) stoic philosophy and (b) established concepts from Te Ao Māori. We argue that recontextualizing mindfulness in culturally relevant terms provides opportunities to enrich both mindfulness theory and practice, allowing for an integration of cognitive-functional and cultural relativist positions.

Ethnic Variations in the Quality Use of Medicines in Older Adults: Māori and Non-Māori in Aotearoa New Zealand

In Aotearoa New Zealand (NZ), ethnic inequities in health outcomes exist. Non-Māori experience better access to healthcare than Māori, including access to the quality use of medicines. Quality medicines use requires that medicines provide maximal therapeutic benefit with minimal harm. As older adults are more at risk of harm from medicines, and, because inequities are compounded with age, Māori older adults may be at more risk of medicines-related harm than younger and non-Māori populations. This narrative review examined ethnic variation in the quality use of medicines, including medicines utilisation and associated clinical outcomes, between Māori and non-Māori older adult populations in NZ. The review was structured around prevalence of medicine utilisation by medicine class and in particular disease states; high-risk medicines; polypharmacy; prevalence of potentially inappropriate prescribing (PIP); and association between PIP and clinical outcomes. 22 studies were included in the review. There is ethnic variation in the access to medicines in NZ, with Māori older adults often having reduced access to particular medicine types, or in particular disease states, compared with non-Māori older adults. Māori older adults are less likely than non-Māori to be prescribed medicines inappropriately, as defined by standardised tools; however, PIP is more strongly associated with adverse outcomes for Māori than non-Māori. This review identifies that inequities in quality medicines use exist and provides a starting point to develop pro-equity solutions. The aetiology of inequities in the quality use of medicines is multifactorial and our approaches to addressing the inequitable ethnic variation also need to be.