Te Whare Mārie is a Porirua-based Māori mental health community service that is part of the Mental Health, Addiction and Intellectual Disability Service (MHAIDS). It offers a range of support, with a crucial cultural perspective, to tāngata whaiora seeking mental health support in Wellington, Kāpiti, and Porirua.
Initially established as a day programme in the 1980s, today Te Whare Mārie employs 30 kaimahi across Porirua, Kāpiti and Wellington, who support around 230 adult and 120 child/adolescent tāngata whaiora.
The CAMHS team at Te Whare Mārie, Te Kākano o te Aroha, has been using CAPA since 2016, when it was woven together with Te Ao Māori to form a framework that meets the needs of Māori. Central to this is a pūrākau, or story, that clinicians use to explain the treatment journey to tāngata whaiora:
Tāne decided to climb up to the heavens to seek the baskets of knowledge for mankind. His brother Whiro te tipua was angry and put obstacles in Tāne’s way, while another brother, Tāwhirimātea, helped him on his journey. Tāne reached the summit of all the heavens and received the three kete/baskets of knowledge. (Adapted from The Knowledge Basket).
“We ask whāiora what is in their baskets - what their goals are - and how they can reach these goals,” explains Team Leader Maire Ransfield. “We ask them to identify who’s going to be their Tāwhirimātea - their support to reach these goals, or their Whiro te tipua – a person who could add obstacles.”
This pūrākau also helps whāiora understand the collaborative nature of CAPA – that they are the experts in their own health, starting on a journey like Tāne, and clinicians are there to offer helpful tools they have in their kete, rather than ‘fixing’ whāiora.
One key change when implementing CAPA was making sure whāiora and whānau are ready to undertake their treatment journey, which Maire says represents a shift to working ‘with’, rather than ‘at’ whānau.
“We have whānau ask themselves - “Do I want to do this, am I ready?” Some whānau might say no – and that's kei te pai,” says Maire. “In the past we may have put people through therapy when they weren’t necessarily ready. But people have to be willing to engage – or it doesn't stick.”
The introduction of therapeutic letters has been another change since the service implemented CAPA. This is a letter from a clinician to whānau summarising an appointment, when they either enter or exit the service. Unlike a clinical discharge note, the language is personal and accessible, and clearly identifies next steps on the treatment journey. At Te Whare Mārie, clinicians incorporate te Reo Māori into their letters.
The Mental health and addiction Change Programme has been an opportunity for Maire to reflect on what she and the team learned while implementing CAPA - an ongoing journey, with tweaks made over time following discussions at regular planning days.
The team is now sharing its processes with others across MHAIDS. For example, Maire has shared information around job planning, and how she has adapted it to meet her team’s needs. Under CAPA, job planning involves a Team Leader meeting with clinicians one-on-one. It's a collaborative process used to calculate how many initial choice appointments and partnerships a clinician can offer, but also encompasses a caseload review and discussions about job satisfaction.
“It’s a good opportunity to talk with people and find out what's going on - to have more direct, consistent kōrero,” says Maire.
“At first it felt as if we were being asked to do more with less. But on reflection it’s the same amount of work, just with a structure that supports it – and the framework offers more transparency for kaimahi.”
Asked for any advice to other teams who are looking to refresh or implement the framework, she says "You need the whole team on board to implement a change like CAPA, and you need champions.”
She also points out the role of leaders in identifying and overcoming issues with implementation. “A choice appointment looks at whether tāngata whaiora meet criteria and whether they’re ready to start their journey to wellness. However, some of our new team members aren’t familiar with CAPA and are getting stuck doing full comprehensive assessments. So, I am retraining and reframing CAPA for people on an ongoing basis.”
