What is the Meihana model?
The Meihana model, developed by Professor Suzanne Pitama (University of Otago) in 2007, is a framework and assessment tool for mental health service delivery when working with Māori. The Meihana model builds on Te Whare Tapa Whā, a holistic model of Māori health developed by Sir Mason Durie in 1984, adapting it for use in mental health services.
The Meihana model aims to better serve Māori in mental health settings by incorporating matauranga Māori (Māori knowledge), te ao Māori (Māori worldview), and te reo Māori (Māori language). The framework encourages the clinician to consider not only the individual, but their whānau, support networks, environment, and wider societal influences. Taking a broader and more holistic approach helps the clinician develop a deeper understanding of the client and their presenting issues.
Western frameworks for assessment and treatment tend to focus on the individual. Failing to acknowledge wider influences on the client's life can lead to culturally inappropriate practice. Culturally sensitive practice in psychology means incorporating the client’s culture and values into therapy. Taking a culturally sensitive approach is important as it has been shown to improve outcomes, help form better client therapist relationships, and help remove barriers in accessing health care.
What are the different components of the Meihana model? What do they mean? And how can they be applied to assessment and treatment?
Hauora:
The Meihana model depicts a waka (double hulled canoe) moving across the water to reach hauora. Hauora is a place of health, wellbeing, and access to quality health care.
Wellbeing can mean different things to different people. Therefore, it is important to take an individual tailored approach to treatment which is informed by the client's values and culture.
Waka - Double hulled canoe:
The two sides of the waka represent the patient and their whānau/ support networks. The Meihana model has a strong focus on whānau, acknowledging that the client is part of a wider group and that this group is key in their own wellbeing. It is important that whānau are involved in the journey to reach hauora.
Crossbeams of the Waka:
- Tinana - Physical body/ symptoms
- Clinicians should be aware of a client’s current and past physical health and other factors that influence health and wellbeing such as exercise, diet, and substance use.
- When taking a holistic approach to health there is an acknowledgement of the relationship between physical and mental health and how the two impact each other.
- Hinengaro - Emotional and psychological wellbeing.
- This is the client's psychological health and their perceptions of wellbeing.
- Iwi katoa - Health/ support services and systems.
- Wider social structures and access to health care can have an impact on wellbeing.
- Wairua - Connectedness or spirituality.
- Wairua can mean a person’s spirituality, connectedness, or ‘level of attachment’. For some this may be a connection to a god or religion. For others this may be their core values or connections with the environment or community.
- Taiao - Physical environment.
- The physical environment includes the home environment, neighbourhood, and access to transport. This also includes potential barriers to accessing healthcare.
Ngā hau e wha - The four winds:
Ngā hau e wha (the four winds) are factors which can get in the way of treatment or “blow us off course”. The winds represent current and historical influences on Māori which can have an impact at individual, interpersonal, and institutional levels.
- Marginalisation
- Colonisation
- Racism
- Migration
Ngā roma moana - The ocean currents:
Nga roma moana (the ocean currents) represent elements of te ao Māori and factors which are important to Māori identity. These are protective factors for wellbeing which interact strongly with the winds.
- Āhua - Personalised indicators of te ao Māori.
- This is a person's connectedness to their identity as Māori.
- Whenua - Connection to place/ land and whakapapa/ genealogy.
- Whānau - Roles, relationships, and responsibilities within family.
- Tikanga - Māori cultural principles and protocols.
Whakatere - Navigation/ treatment:
The sail represents a bringing together of all elements within the Meihana model. Incorporating all elements helps to inform the clinicians assessment and form a treatment plan which is best for the individual and their whānau.
If you would like to learn more, here is a link to Professor Suzanne Pitama’s public lecture on the Meihana model - https://www.youtube.com/watch?v=rJxLMF7UTak