Recognising the significance of Te Tiriti o Waitangi

Tu Te Akaaka Roa (the New Zealand National Committee) and Te Kaunihera, working with other Committees including the New Zealand Training Committee and Vocational Education and Advisory Body Committee, have developed this position statement to ensure Te Tiriti informs the RANZCP’s mahi (work) undertaken within a New Zealand context. 

The position statement will support the RANZCP’s policy and advocacy work, inform overseas trained psychiatrists, and be a reference document for training purposes and for continuing professional development (CPD) activities.

Key messages

• Te Tiriti o Waitangi is a founding document that is fundamental to social and health policy in Aotearoa New Zealand.
• The RANZCP recognises the significance of Te Tiriti and commits to meeting its responsibilities and ensuring that the principles guide all aspects of the RANZCP’s mahi.
• Meeting our responsibilities under Te Tiriti will make a contribution to improving Māori mental health outcomes.
• The RANZCP commits to actions to enact the principles of Te Tiriti across its membership and the organisation.

Introduction

Te Tiriti o Waitangi (Te Tiriti or Treaty of Waitangi) is a living document that is fundamental to the relationships between Māori (known in Aotearoa as Tangata Whenua) and Tangata Tiriti (People of the Treaty e.g. non-Māori). Te Tiriti influences all aspects of life in Aotearoa New Zealand. A glossary is provided at the end of the document.

Medical Professionals, the health system and Te Tiriti

Te Tiriti is a founding document that is fundamental to social and health policy in Aotearoa New Zealand.

The Waitangi Tribunal’s seminal Hauora Report[1] notes that Te Tiriti places responsibility on the Crown to ‘to protect actively Māori health/hauora and wellbeing through the provision of health services’. The Report also states that ‘any part of the health service’ must ‘keep itself informed’ on the needs of Māori including achieving equity. In Aotearoa New Zealand, the RANZCP as a health sector organisation has responsibilities under Te Tiriti.  

Honouring Te Tiriti and implementing its principles are driving transformational change across New Zealand society. The RANZCP as a health sector organisation has a responsibility in embedding Te Tiriti across all levels of the membership. Doctors in training must develop skills, knowledge and practice that lifts their understanding of cultural safety; consultants must continue on this ara (path) by undertaking CPD activities that enhances their knowledge of Te Tiriti and leads to culturally appropriate care. All psychiatrists should be supported by the RANZCP, so they are able to advocate for equitable outcomes for Māori.

Key documents that underpin medical professionals’ obligations to Te Tiriti are listed on the Medical Council of New Zealand’s website. [2] The Mental Health (Compulsory Assessment and Treatment) Act 1992 also articulates the importance of Te Tiriti in delivering care and treatment that is aligned with tikanga principles. The Health Practitioners Competence Assurance Act 2003 states at s 118 (i) that health professionals must be culturally competent. In summary, this body of work gives impetus for the RANZCP to develop their own Position Statement on the context of Te Tiriti within the delivery of psychiatric care.

He Korowai Oranga (the Māori Health Strategy) and Whakamaua (the Māori Health Action Plan) were developed by the Ministry of Health as an overarching framework to guide the Government and the health and disability sector to achieve the best health outcomes for Māori. In future, the Government will be guided by the Māori Health Authority, which is due to be established in 2022 as part of the Health and Disability System changes.

Health equity

Equity for Māori and commitment to Te Tiriti are intertwined. The basis for improving health outcomes for Māori is linked to Tino rangatiratanga (self-determination) and supporting Māori to deliver healthcare that is ‘developed by Māori for Māori’, e.g. grounded in a kaupapa Māori approach to health care and wellbeing.[3] The evidence is clear that Māori health equity will not be achieved unless kaupapa Māori approaches are valued and effectively integrated within the health service. Several Acts highlight this important connection between enacting Te Tiriti and improving health outcomes for Māori. It is acknowledged that honouring Te Tiriti will benefit all people using health services in Aotearoa - ‘if we can get it right for Māori, the greatest equity challenge in our work, we will get it right for everyone else’.

Background to Te Tiriti o Waitangi

Te Tiriti o Waitangi is Aotearoa New Zealand’s founding document outlining the relationship between Māori and the British Crown. It was signed in 1840 and there were two versions of the document – one in Te Ao Māori (the Māori language) and one in English. The vast majority of rangatira (chiefs) only signed the Māori version, and under international law, preference is given to the Indigenous text.   

Te Tiriti is preceded by He Whakaputanga o te Rangatiratanga o Nu Tireni (He Whakaputanga or The Declaration of Independence of New Zealand) in 1835, which affirmed tino rangatiratanga (sovereignty).

Articles of Te Tiriti o Waitangi 

The written text of Te Tiriti o Waitangi has three articles.:

• Article 1: Rangatira give the Queen ‘kawanatanga’ (governance) over the land
• Article 2: the Queen agrees to protect ‘tino rangatiratanga’ (sovereignty) of rangatira over their whenua (lands), kāinga (villages) and taonga (treasures)
• Article 3: the Queen agrees to protect the equal rights of the people of New Zealand.[4]

Under Te Tiriti, Crown-funded health providers have a responsibility to:

• exercise their responsibilities in ways that enable Māori to live, thrive and flourish as Māori
• enable Māori to exercise tino rangatiratanga / authority over their own health and wellbeing
• contribute to equitable health outcomes for Māori.[5]

Meeting our responsibilities under Te Tiriti will make a small but significant additional contribution to improving Māori mental health outcomes.

Principles of Te Tiriti o Waitangi

The Articles of Te Tiriti o Waitangi have been interpreted and expressed through a set of principles.
The principles have evolved over time and provide direction for how we are obliged to consider these principles and reflect on the implications for our mahi as a health organisation.

The principles underpinning Te Tiriti, by which the RANZCP can demonstrate its commitment to Te Tiriti are:

Tino Rangatiratanga / Self-Determination

The principle of self-determination – this provides for Māori self-determination and mana motuhake. It requires the RANZCP to support by Māori for Māori approaches and services, and advocate for tino rangatiratanga to be enshrined within the wider system.

Pātuitanga / Partnership

The principle of partnership. This requires all parts of the RANZCP to work with Māori in the design, delivery and monitoring of all our mahi/work.

Mana Taurite / Equity

The principle of equity – this requires the RANZCP to commit to achieving equitable health outcomes for Māori through all its functions.

Whakamarumarutia / Active Protection

The principle of active protection – this requires the RANZCP and all members to be well informed on the extent and nature of both Māori health outcomes and ways to achieve Māori health equity through culturally safe practice.

Kōwhiringa / Options

The principle of options – this requires the RANZCP to ensure that all its services are provided in a culturally appropriate way that recognises and supports the expression of Te Ao Māori.

More information can be found on the principles at Waitangi Tribunal. A Guide to the Principles of the Treaty of Waitangi as Expressed by the Courts and the Waitangi Tribunal.

Recommendations

The development of this position statement is but a first, important step in the journey the RANZCP is on to ensure that members and staff understand the implications of Te Tiriti in all our mahi/ work.

To support this journey the RANZCP will:

• Develop a plan outlining the necessary actions required by the RANZCP to enact the principles of Te Tririti.
• Actively embed Te Ao Māori perspectives within all curricula, training and continuing professional development programmes, policy and advocacy documents. This action includes acknowledging and valuing tikanga Māori in our internal documents such as governance, committee hui and conferences.
• Ensure RANZCP communications (oral, written and web-based) reflect Te Tiriti and culturally appropriate wording, imagery and content. This activity includes acknowledging and honouring Te Tiriti in key RANZCP documents.
• Take steps to recruit Māori staff and ensure our workplace is culturally safe for Māori.
• Ensure members are culturally safe by developing a plan to implement a Māori cultural safety/ competence programme for the RANZCP committees, consultants and trainees. The Takarangi Competency Framework is an example of a programme that supports a greater understanding of Te Ao Māori, including Whānau Ora. The aim of the programme is to encourage ongoing development of culturally safe practice and skills within the mental health and addiction sector. 
• Provide resources to improve knowledge, attitudes, and skills in tikanga Māori and Te Reo Māori within the membership and staff.

This position statement sits alongside the Position Statement 104 on  Whānau Ora | RANZCP.

Resources

Overview of Te Tiriti O Waitangi

New Zealand History has developed a brief overview of Te Tiriti o Waitangi and also includes some frequently asked questions. This might be a useful site to visit if you need an introduction to the TeTiriti.https://nzhistory.govt.nz/politics/treaty/treaty-faqs#WhatistheTreatyofWaitangi

This website also makes reference to He Wakaputanga o te Rangatiratanga o Nu Tirene (the Declaration of Independence of New Zealand) which was signed before Te Tiriti. https://nzhistory.govt.nz/politics/treaty/treaty-faqs#WhatwastheDeclarationofIndependence

The Waitangi Tribunal has developed their own guide on the Te Tiriti o Waitangi  - A Guide to the Principles of the Treaty of Waitangi as Expressed by the Courts & the Waitangi Tribunal.He Tirohanga o Kawa ki te Tiriti o Waitangi (waitangitribunal.govt.nz)

Linking the Te Tiriti O Waitangi to hauora (health)

The Ministry of Health has developed a range of documents that describe the importance of Te Tiriti in relation to Māori health. The whakamaua framework is useful as it integrates the principles of Te Tiriti o Waitangi with the Ministry’s future vision for Māori health (Pae ora). Te Tiriti o Waitangi Framework (health.govt.nz). The Ministry’s vision is further articulated in The Guide to He Korowai Oranga – Māori Health Strategy | Ministry of Health NZ

The WAI 2575 Health services and outcomes kaupapa Inquiry. The Waitangi Tribunal Inquiry’s deal with nationally significant issues affecting Māori as a whole. The WAI 2575 claim concerns grievances relating to health services and outcomes and several useful reports have been published Health Services and Outcomes Inquiry | Waitangi Tribunal  and a specific  report on mental health is available  Wai 2575, 2.3.006.pdf (justice.govt.nz)

The Medical Council of New Zealand has published several papers that describe the link between Te Tiriti and equity, good medical practice and cultural safety.

 He-Ara-Hauora-Maori-A-Pathway-to-Maori-Health-Equity.pdf (mcnz.org.nz)

Cultural-Safety-Baseline-Data-Report-FINAL-September-2020.pdf (mcnz.org.nz)

The Takarangi Competency Framework’s objective is to ensure practitioners demonstrate cultural safety in practice rather than just focusing on knowledge. A fact sheet outlines the development and the key concepts of the Framework. takarangi-competency-framework-fact-sheet.pdf (tepou.co.nz).

The Framework is based on Māori values defined by fourteen competencies and these are summarised in a useful poster Takarangi competency framework fact sheet | Cultural… | Te Pou

Glossary

• Hauora –    Be fit, well, healthy, vigorous, in good spirits. (aligned with Whanau Ora)
• Kaupapa – A way of doing things from a Māori perspective – the way Māori think, act, and make decisions and plan
• Mana Motuhake - Self-determination
• Mahi – work, to do
• Te Ao Māori – Māori world view
• Tikanga – custom, protocol, way, or manner

Responsible committee: Tu Te Akaaka Roa (the New Zealand National Committee) and Te Kaunihera 

References

1. Treaty of Waitangi Tribunal. Haurora Report on Stage 1 of the Health Services and Outcomes Kaupapa Inquiry. 2019. Available at Report on stage one of health services and outcomes released | Waitangi Tribunal
2. Medical Council of New Zealand. He Ara Hauroa, 2019.  Available at  He-Ara-Hauora-Maori-A-Pathway-to-Maori-Health-Equity.pdf (mcnz.org.nz)
3. Ministry of Health. Māori Health Models: Te whare tapa whā. 2017. Available at  Māori health models – Te Whare Tapa Whā | Ministry of Health NZ. The Ministry notes this model was developed by Emeritus Professor Sir Mason Durie.
4. Archives New Zealand https://www.archives.govt.nz/discover-our-stories/the-treaty-of-waitangi
5. Archives New Zealand https://www.archives.govt.nz/discover-our-stories/the-treaty-of-waitangi

Disclaimer: This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available.