Massey University lecturer and nursing graduate Dr Sione Vaka has completed his PhD research, which shows that Tongan people’s understanding of mental illness is very different from that of New Zealand’s mainstream hospital system. These differences could affect future mental health treatment options for New Zealand’s Tongan community.
Sione’s research, which was funded by a HRC Pacific Health Research PhD Scholarship, has focused on understanding Tongan cultural attitudes towards mental health. Initially, Sione wanted to explore why the 2006 ‘Te Rau Hinengaro: The New Zealand Health Survey’, showed that Pacific people born in the islands have a lower risk of developing mental illness than those who are born in New Zealand. However, as Sione began his PhD, he says it became clear that he needed to first find out what mental illness means for Pacific people. Coming from Tonga himself, Sione decided to drill his study down to focus on the Tongan community because “while there are similarities between Pacific communities, we also have our important differences”.
“I’m really glad that I asked ‘what does mental illness mean for Tongan people?’ first. All the time we’ve been talking about depression, yet our Tongan community doesn’t think of depression in the same way as the New Zealand health system. There’s not even a Tongan word for depression or schizophrenia. Sometimes in the health field, we try to get in and fix the problem quickly, rather than first ask what the problem actually is,” says Sione.
For his study Sione used the traditional talanoa process of telling stories with seven groups of Tongan men, women, community leaders, service users of mental health services, families, and young people. The participants were a mix of those who were born and grew up in New Zealand and those who were born in Tonga. After analysing his findings, Sione classified Tongan constructions and understandings of mental illness into three main categories:
- The Tongan construction of mental illness. This approach views people with mental illness as being “possessed by the spirit” or suffering from “illnesses from the grave”. Sione says this view is strong in the Tongan community, especially among men and community leaders. “In the traditional Tongan view, health is about our relationship with the living and the supernatural world. Any disruptions to this relationship causes illness. In terms of treatment [for mental illnesses], people will try to find a healer who can restore those relationships that have been broken rather than go to hospital.”
- The biopsychosocial construction of mental illness. This approach views biological (e.g., chemical imbalances in the brain), psychological (e.g., thoughts and emotions), and social factors as all playing a part in a person’s state of mind. This view is predominant in the New Zealand health system and is more common among young New Zealand-born Tongans. “New Zealand’s hospital system focuses much more on the relationship between the physical processes of the brain and mental health, whereas the Tongan view focuses more on the spiritual side,” says Sione.
- An intersection of the Tongan and biopsychosocial constructions of mental illness. Sione found that this combined approach was more common among Tongan women and families.
Sione says his findings suggest that our mental health system’s cultural services may not be taking into account the views of different groups within an ethnic community.
“Sometimes our health system’s cultural services might suit only one group of people. For example, New Zealand-born Tongan youth might think that the traditional Tongan construct is not really helping them, and they are happy to be in the hospital system. However, it might be a different story for those youths’ parents who may have been brought up in the traditional system.”
Sione has been approved the award of Doctor of Philosophy for his thesis and plans to graduate with his students at Massey University’s School of Nursing in April next year. After that, he would like to return to his original research proposal and explore why New Zealand-born Tongans are more at risk of mental illnesses than those born in Tonga. He suspects that the 2006 New Zealand Mental Health Survey may have only picked up those in the Tongan community who accessed the hospital system, and not those who went to traditional healers.
“It would be really interesting to find out why our Tongan kids born here are at higher risk of mental illnesses. Do they access hospital care or traditional healers? There are other issues to consider as well. Growing up in Tonga, the social network is strong. In New Zealand, society is more fragmented and drugs and alcohol are much more readily available.”
With the World Health Organization predicting that mental illness will be the second biggest health issue facing the globe by 2020, only behind heart disease, Sione says it’s very rewarding that his research has contributed new indigenous knowledge to the mental health field.
“My people have been struggling here in New Zealand. This study has informed health services that this is how Tongan people feel about mental illness, and the findings could translate to other Pacific groups as well."
* Dr Sione Vaka will be presenting his findings on Tongan constructions of mental illness at the International Pacific Health Conference in Auckland on 3–5 November 2014.