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| Hale Na'au Pono, also known as the Wai'anae Coast Community Mental Health Center, helped the state Department of Health integrate culture into a national model of delivering mental health practices. - Photo: Courtesy of Hale Na'au Pono |
Who is culturally competent to treat mental health issues of Kanaka Maoli?
State health officials in June ended a major contract with Hale Na'au Pono, Wai'anae's largest provider of mental health services and announced plans to transition the majority of the clinic's patients to another state-run facility.
The private nonprofit Hale Na'au Pono is currently challenging the state's decision and vowing to find a way to keep operating in a community made up largely of Native Hawaiians. The dispute between the state and the clinic centers outwardly on contract compliance and treatment protocols. But it has also raised widespread concerns about the severity of mental health needs in Wai'anae and other areas with a high concentration of Hawaiians.
Both the state and the Hale Na'au Pono agree with the theory that culture matters when it comes to Kanaka Maoli mental health issues. But in the following editorials, they offer differing perspectives on their respective qualifications to deliver culturally based mental health treatment. — Liza Simon
Who is culturally competent to treat
mental health issues
of Kanaka Maoli?
Hale Na'au Pono has filed an appeal with the Department of Health over the Department's decision to not extend its contract that expired on June 30, 2008. Because of the pending appeal, we cannot discuss that decision here. However, we welcome this opportunity to provide useful information on mental health services on the Leeward Coast.
In June 2008, the Department of Health (DOH) served more than 1,500 consumers with mental illness in the Wai'anae area. Only about one-quarter of those individuals were served by Hale Na'au Pono. The remaining consumers in the Wai'anae area were served by more than a dozen other state-operated and privately contracted service providers, all of which employ staff that represent the ethnic diversity of the Wai'anae region, some of whom live on the Leeward Coast and, therefore, are familiar with the issues and concerns of their neighbors.
Some of these service providers already have offices on the Leeward Coast. Others are actively developing satellite offices in Wai'anae to better serve the growing population and ensure that consumers will be served in the location of their choice, whether it is in their home, a beach park, or any other location within their community. This is consistent with the consumer-driven philosophy adopted by the Department that removes barriers to access by serving consumers in a setting that the consumer feels most comfortable in.
In addition, the DOH is committed to increasing the level of cultural competency among its service providers through our Office of Multicultural Services, led by Dr. Kimo Alameda. Dr. Alameda, who recently received an award from the Mental Health America of Hawai'i for being an Outstanding Government Agency Leader, is credited for increasing awareness of the need for Hawai'i's mental health system to address the diverse cultural issues of consumers. Dr. Alameda provides technical assistance and support to service providers requesting consultation on issues of culture and diversity.
As far as eligibility, it all starts with making the call. Any resident of Hawai'i may contact the Department's ACCESS line at 832-3100 on O'ahu or 1-800-753-6879 toll-free from the neighbor islands to request mental health services funded by the Adult Mental Health Division (AMHD).
If the ACCESS caller is experiencing a mental health crisis, a Crisis Mobile Outreach Team will be sent to the person to offer immediate assistance. If the person is not in crisis, but would like to receive ongoing mental health services, the ACCESS Specialist will offer the caller an appointment to determine eligibility for AMHD-funded services. If eligible, the ACCESS caller will be referred to the service close to their residence and appropriate for their needs.
Who is culturally competent to treat
mental health issues
of Kanaka Maoli?
Twenty years ago, the position that communities are better than the state to deliver good mental health practices was put to the test. Wai'anae folks invited the State out of the community because services were inadequate and culturally inappropriate for the people. DOH turned responsibility over to the newly formed Wai'anae Coast Community Mental Health Center, while maintaining control over eight other community mental health centers.
Wai'anae's Hale Na'au Pono, became the first, and today the only Hawai'i community mental health center to be nationally accredited (five times, three years in each cycle). It won first place nationally for its style of case management services for organizations with an annual operating budget of less than $10 million. Dr. Kenneth Minkoff, Federal Court Monitor, applauded our work and declared that all mental health workers should visit this agency to understand good community practice. HNP has gained local and national recognition for its cultural practices, helped develop a national curriculum for teaching professionals treating Pacific Islanders and Asian Americans, and has shared its successful experience time and again, locally, nationally and internationally.
When the DOH's Adult Mental Health Division needed to make cultural adaptations to a U.S. “Best Practice” model, they turned to Hale Na'au Pono. We used down-to-earth language, added chapters on techniques of building relationships, and built in the Spiritual (Akua) and Environmental ('Āina) dimensions to the biological/social (Kanaka) approach in Western mental health practice. The result is our “Voyage to Recovery” formulated around the Kumu Ola Pono, (Wai'anae Wellness Model).
Every individual's recovery at Hale Na'au Pono has a place for all three dimensions, allowing for a cultural, spiritual and social role in the individual's recovery program.
“Voyage to Recovery” is taught at the UH, praised at State conferences, under study in indigenous communities and universities across America and primed for export by the State across the Pacific.
Community organizations can better deliver culturally appropriate services because they are the culture. They model the community and mold the cultural practice into meaningful and effective treatment. Eighty percent of HNP's staff lives in the community. One-hundred percent of the board are from Wai'anae. Community organizations understand the value of human relationships in the treatment of fellow human beings, rather than relying exclusively on professional diplomas and tittles as the measure of competency. They can practice aloha and pono without having to adopt a written policy to prove that they do. They respond more quickly to community needs. They can more effectively attain the fifth golden rule of Hale Na'au Pono – to transcend the difference between self and others, recognizing that each one of us, whether healer or patient, is equal in human dignity, entitled to equal respect, and to the best care we are able to provide.
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