Situating Risks. Constructing Family and Whānau Consultation - A Discourse Analysis

Abstract

Approximately 10,000 New Zealanders per year experience compulsory assessment and treatment for a mental disorder, leading to possibilities of hospitalisation and other practices mandated under the Mental Health (Compulsory Assessment and Treatment) Act, 1992 [MHA, 1992]. This thesis is concerned with the practice of Section 7A consultation occurring between the family and whānau of a person undergoing compulsory assessment and treatment and the responsible clinician overseeing the process under statutory law. Since the 1990s, Aotearoa New Zealand health policy, frameworks and strategic documents have increasingly promoted family and whānau ‘inclusion’ in mental health service delivery and planning, including compulsory practices, as ‘best practice’. However, uptake has been limited; and family and whānau continue to describe stigma and other barriers to inclusion. No research in Aotearoa New Zealand has focused on exploring the complexity of family and whānau consultation and possibilities for future practices. This study aimed to address that gap. A poststructural methodology was used to consider the conditions enabling and restricting family and whānau in past, present, and future iterations of consultation. I chose a Foucauldian genealogical approach for my inquiry to interrogate family and whānau involvement in mental health consultation practices. I analysed texts from the 1950s to the present to make visible assumptions and norms underlying contemporary practices through a ‘history of the present’. My study has provided a unique insight into how historical representations of family and whānau continue to play out in contemporary practices. My analysis exposed how early constructions of family as a site for the emergence of mental illness provided the possibilities and limitations for their inclusion in mental health practices. An intersection between responsibility, rights, and the notion of different forms of ‘expertise’ from the 1980s, characterised family and whānau as support systems. Notions of consultation emerged as thinking and practices to promote and assist family and whānau involvement for the successful functioning of community care. The integration of consultation into the MHA, 1992, in 1999 as Section 7A, embodied European individualistic values. Analysis of contemporary texts identified that greater acknowledgement of Te Ao Māori (world view and cultural practices) in policy has shifted services away from individualistic (patient centred) towards collectivistic approaches. However, barriers to consultation continue through discursively situating risks in family and whānau. The thesis concludes by noting how consultation continues to operate as a tool of colonisation. Although functioning to hinder equitable practices, recent shifts in policy provides some hope for more inclusive practices.