Ka Wai Ola - Office of Hawaiian Affairs, Volume 8, Number 3, 1 March 1991 — Hawaiian Health Horizons [ARTICLE]

Hawaiian Health Horizons

Renewal of Hawaiian values linked to qood mental health

This is the second article in a five-part series summarizing the findings of the E Ola Mau Native Hawaiian Health Needs Study conducted in 1985. Its findings and recommendations led, in part, to passage of the Native Hawaian Health Care Act of 1988 whieh established the Papa Ola Lokahi Hawaiian health consortium.

The consortium's five member agencies — the state Department of Health, E Ola Mau, the University of Hawai'i, Alu Like, and Office of Hawaiian Affairs — are working with island communities to develop a comprehensive health care master plan for Native Hawaiians and a network of Native Hawaiian health care systems statewide.

Report of the E Ola Mau/Native Hawaiian Health Need Study Part 2 of a series A study of the mental health needs of Native Hawaiians in Hawai'i was conducted over a threemonth period by an eight-member task force working under the auspices of Alu Like, ine., a Native Hawaiian community action organization. Task force members included a spectrum of service providers and researchers familiar with Native Hawaiian mental health problems. Four members of the task force were Native Hawaiians.

The specific purposes of the study were: 1) to identify existing data bases and reports about Native Hawaiian mental health, especially those concerned with psychiatric disorders, and how Hawaiians used services; 2) to assess how valid or reliable these reports were; 3) to collect and generate needed supplemental data; 4) to prepare a eulturally relevent context; 5) to prepare an extensive bibliography of relevant English language and Hawaiian language mental health materials; 6) to prepare supplemental materials including glossaries, personal statements, and literary quotations; and 7) to prepare conclusions and recommendations. However, the task force was strongly aware of the cultural illness.

The report asserts that it is important to recognize and be responsive to traditional Hawaiian conceptions of health rather than impose Western concepts, since it was the imposition of Western values and lifestyles that led to mueh of the cultural dislocation and disintegration leading to the current crisis in Native Hawaiian mental health.

The report asserts that Native Hawaiian mental health needs are the result of a complex historic pattern of injurious eeonomie, political, educational, and social circumstances whieh have deprived the Native Hawaiian of the necessary foundations for promoting and maintaining good mental health. These include: 1) a positive sense of ethnic identity; 2) a positive self-concept and sense of self-worth; 3) a culturally consistent set of values and beliefs whieh are at least partially eontinuous with historical tradition; 4) a respect for one's ancestry and heritage; 5) a sense of political and eeonomie empowerment; 6) a social formation whieh supports these characteristics; 7) a health system whieh provides accessible and acceptable services; and 8) an opportunity to establish and maintain a strong attachment to the 'aina (land).

Lokahi as key In contrast to Western concepts of mental health whieh frequently separate psychological and physical functioning, traditional Hawaiian conceptions emphasize the unity of body, mind, and spirit. The harmony of these dimensions emerges from a sense of psychic relationship with the land, the sea, and the spiritual world. For many Native Hawaiians, the detachment from traditional beliefs and lifestyles based on harmonious relationships with nature and the spiritual world

created a feeling of having low value, helplessness, and alienation. The report emphasizes the importanee of promoting traditional beliefs and lifestyles as alternatives to Western ways. The task force recognized that along with the benefits from increased westernization for Native Hawaiians, there are also many risks, where this process is not somehow balanced with promotion of Hawaiian culture. Generations whieh did not

maintam cultural values lost valuable roots for socialization and social control, for guiding morality and relationships. Many Hawaiians lost their sense of continuity with the past and feeling of community. Many Native Hawaiians feel that they are strangers in their own land, unwelcomed outcasts in society. The outcomes of this condition are reflected in high rates of mental illness, substance abuse, crime, delinquency, alienation, and a pervasive sense of anger and frustration.

The task force also asserts that traditional Hawaiian values may actually offer Western people an important alternative for finding personal meaning and growth in our contemporary world. Who is the Native Hawaiian popuIation? The report's analysis of existing social and demographic data at the time revealed that Native Hawaiians constitute approximately 12 percent to 18 percent of the state's population, depending upon the definition of "Hawaiian" whieh is used. Because public and private agencies use different definitions of Native Hawaiian this

creates a serious problem in identifying the Native Hawaiian populahon and its needs. Because there are many different patterns of identification with Native Hawaiian lifestyles, it is therefore difficult to see Native Hawaiians as a uniform group. However, the largest numbers of Native Hawaiians include those who are disenfranchised from participating in the dominant Amehean society and who are forced to live marginal existences caught between a devalued past and unacceptable present and future.

Native Hawaiians are, on the average, younger than the state population and live in larger households and families. There are more female household heads among Native Hawaiians. In addition, Native Hawaiians have lower levels of educational attainment and lower average incomes. They are also less likely to be employed in executive, managerial, and professional positions. General findings In comparison to statewide populahon estimates, Native Hawaiiians have: • Higher proportions of social problems with family, people, and children, including higher proportions of assaultive acts and antisocial behavior; • Higher proportions of aleohol and narcotics use;

• Higher proportions of school performance impairment; • Higher rates of suicide among young adult and elderly males; • Higher rates of child abuse and neglect (second only to Samoan populations); • Higher rates of residence in correctional institutions; • Higher rates of academic failure and poor school performance; and

• Higher levels of stress as indexed by leading stress markers including poverty, educational level, single family households, dwelling density, and so forth. Native Hawaiians also under-utilize present mental health services because they fail to aeeommodate Native Hawaiian values and lifestyles. Treatment programs make little use of Hawaiian values and norms, or Hawaiian beliefs to describe problems. There is little awareness of Hawaiian cultural beliefs and practices regarding health,

mueh less use of Hawaiian language terms in health care. The report also found virtually no training in Hawaiian culture is provided to public mental health workers. Today (in 1985) there are still very few Native Hawaiian mental health professionals. There are some examples of successful Hawaiianbased mental health programs such as Hale Ola and the Opelu Project, but these are exceptions and even they do not receive the full financial support deserved and required to achieve their goals. The outcome of this indifference and this failure to accommodate Native Hawaiian ways of life is an absence of professional resources for mediating mental health problems and high personal, social, and eeonomie costs to the community.

There is an extensive history of Hawaiian health beliefs and practices whieh could be used to provide culturally relevant mental health services. Practices such as ho'oponopono and lomilomi could easily be included in existing service delivery programs. The former is a potent form of counseling whieh has proved to be a successful method of intervention throughout the Native Hawaiian community. But what is required in order to implement these health beliefs and practices is a major change in the ideologies and practices of the public mental health system.

Perhaps the most positive sign of hope is the growing sense of activism among Native Hawaiians taking on the challenge to promote mental health. The report documents an extensive series of organizations and activities whieh reflect the Native Hawaiian struggle for empowerment, cultural pride, and competence. They demonstrate the potential vitality whieh is present in the Native Hawaiian — a vitality whieh could be used as the basis of promoting Native Hawaiian mental health and preventing illness and alienahon.

Recommendations The task force's report that makes recommendations for both programs and research. These include: 1. Renewal and perpetuation of Hawaiian values to promote pride, self-confidence. and personal power among Native Hawaiians. 2. Development of mental health services whieh are community-based and controlled by Native Hawaiians and whieh are committed to Hawaiian culture, history, and language. 3. Development of educational training programs to increase the number of Native Hawaiian mental health professionals. 4. Creation of cultural sensitivity and awareness programs for mental health service providers as continuing education programs. 5. Development of political, eeonomie, educational, and social programs to encourage empowerment of Hawaiians.

6. Development of more programs to increase the availability of land to Native Hawaiians since it is from a relationship with the 'aina that all mental and spiritual health flows. The task force proposed relevant research into Native Hawaiian mental health needs identified by the study, that follow these guidelines: 1) mental health researchers should be aware of and sensitive to Native Hawaiian culture, history, and language; 2) research should help build community competence; and 3) Native Hawaiian people should be involved in the planning, conduct, and interpretation of investigations.

oome research recommendations were as follows: • Conduct social studies focusing on role expectations, performances, and adjustments rather than psychiatric studies, whieh emphasize rates of severe mental disorders. • Conduct studies of natural support systems and networks.