Nau mai, welcome to our third pānui to update you on the progress with Te Kete Rongomau.
Today, we feature Maryanne Richardson, the first of our two Project Managers based in Rotorua at Health New Zealand Te Whatu Ora Lakes. Next time, we will feature Debbie Goodwin and Areta Ranginui Charlton, based in Hamilton at Health New Zealand Te Whatu Ora Waikato and Waikato University.
We also share some exciting findings from a literature review on the creation of Advance Directives for mental health and when they come into effect – findings that have significant national and international ramifications regarding human rights.
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Kōrero with Maryanne Richardson
What is your role in the Te Kete Rongomau project?
My role in this project is the Project Manager for Health New Zealand Te Whatu Ora Lakes, which is one of two health districts to undertake this research. The role involves coordinating a small team to assist in consulting with our tāngata whaiora, whānau and staff to find out what they would like to be included in Mental Health Advance Preference Statements (MAPS) and what would help and hinder in developing these. The next part is to design and implement the templates and resources within the Lakes Mental Health and Addiction services and then to evaluate whether MAPS were followed or not and the reasons for this.
The role has been challenging at times, but it has also been very rewarding and stimulating. Being involved in something as important as MAPS is amazing. Sometimes, I wish I had MAPS many years ago. It would have helped to support decisions about my own care and treatment.
Can you tell us about your background and where you grew up? Where do you whakapapa to?
I was born in Tauranga but moved a bit because my dad was a Bank Manager. I lived in Coromandel Township, Raetihi, and Stratford. Then, Dad retired, and we returned to Tauranga to be closer to family, where I went to Otumoetai Intermediate and Otumoetai College. After leaving school, I went to the University of Waikato and gained a Bachelor of Social Science Degree, majoring in Psychology.
I am a Pakeha New Zealander. My heritage is Scottish, English and German. My early ancestors have been in New Zealand since 1842.
Most of my family still live in Tauranga, and I consider this my turangawaewae. I also have connections to Waihi, Taranaki, Nelson and Takaka.
Where do you live now, and what do you love about your region?
I now live in Rotorua. My husband and I moved from Auckland to Rotorua in July 2022. This is my second time living in Rotorua, as I lived here between 1987 and 1991. I love this area because there are lots of places to visit and lovely areas for walking, like the Whakarewarewa Redwood Forest and the Rotorua Lakefront. It is also quite central to places like Hamilton, Taupo, Whakatane and Tauranga. It means I am closer to family, but not too close!! 😊
What influential experiences or people in your early life shaped who you are today?
The one person who had a great influence on me in my very early years was my dad. Sadly, he died of cancer when I was thirteen years old. He gave me the love of learning and reading. He was a quiet man who kept many things to himself but had a great sense of humour. He also loved gardening, which is something I have also picked up since moving to Rotorua. We have a small garden, and I find it really satisfying to grow my own vegetables and be able to go out and pick them ready for dinner or give them away to the Community Pantry if we have a surplus.
What inspired you to pursue your current path or career?
After completing my degree, I decided not to pursue a career in psychology, due to becoming unwell. I applied for a role in Rotorua evaluating the Priority Area Programme, a new initiative funded by the Department of Health (now the Ministry of Health). This inspired me to continue my career in evaluation, primarily using qualitative design approaches. I have had evaluation roles in Presbyterian Support (Northern) and Workbase, a workplace literacy organisation. My last job was with Counties Manukau Health as the Lead Evaluator for a small consumer (lived experience) evaluation team.
What benefits do you see resulting from the work being done with Te Kete Rongomau?
The benefits I see from this work are tāngata whaiora having more of a say, as part of supported decision-making, in their care and treatment and clinical staff understanding more about them as a person, including their values and beliefs.
What challenges do you envisage?
The biggest challenge I see is staff not implementing people’s preferences once they have completed a MAPS and putting barriers in the way to prevent this. This would also include staff still not accepting a supported decision-making process for recovery and taking the view that a coercive medical-based model is best for tāngata whaiora when they become unwell.
What do you like doing for fun? Are there any hobbies or interests people might be surprised to learn about?
I am actively involved in the Ulysses Motorbike Club, a motorbike club for people over 40. My husband and I have travelled all over New Zealand on the 1500 Gold Wing tourer we used to own. Sadly, my husband doesn’t ride anymore due to balance issues, but we are still actively involved with the Rotorua Branch of the club and go to events by car instead.
I love volunteering, too. On Thursday mornings, I volunteer for Friends of the Emergency Department, St Johns, here in Rotorua. It can be very busy, but talking to people and trying to make them feel a bit more comfortable during their time in the ED is lovely. When I lived in Auckland, I volunteered at the Auckland Zoo for nearly 15 years and 10 years at Radio Lollipop at Starship Hospital.
In my spare time, I also like to do paint by numbers, mindfulness colouring and crossword puzzles.
Do you have a nickname that you’re willing to share?
My nickname is Scorpy. My husband coined the name not long after we met. The reason for the name is because my star sign is Scorpio. He reckons, “I am small and dangerous with a sting in my tail!!!” 😊 So, the name stuck. I even have a personalised plate with my nickname on it – Scorpy.
Can you share a valuable lesson you’ve learned on your journey?
The one big lesson I have learned is to try to be kind. You don’t always know what other people are going through, but you can always be kind in how you react and relate to them. I think this is why I love volunteering as you are helping people in some way and giving of yourself in kindness.
That’s about it from me and my feather babies Monje, a Quaker parrot and Lulu, a green-cheeked Conure. They are another story of my life 😊
A new – exciting – definition of MAPS
We have always been clear that Te Kete Rongomau is about mental health advance preference statements (MAPS) being a tool to facilitate supported decision-making—that is, support based on the will and preferences of the person concerned. However, we overlooked that the CPRD Committee General Comment on Article 12 provides specific guidance on advance directives. The commentary provides an interpretation of Article 12, stating an advance directive comes into effect (and stops being effective) based on the decision of the person who wrote it, not on an assessment that the person lacks mental capacity.
Consequently, we have changed our definition of a MAPS from being a way to let people know what we would like to happen if we experience an episode of mental distress and are unable to communicate our will and preferences to be a way for you to let people know what you would like to happen at any time, you choose, in the future.
We are also undertaking a literature review to see if any studies examine the use of MAPS in a way that conforms to the CPRD Committee's direction. So far, the review suggests that very few to no studies are informed by this direction.
From a research perspective, this is very exciting. It is almost unheard of to identify an area of knowledge that doesn’t exist, especially one on an international scale. Our project will be addressing this knowledge gap. But most importantly, from our perspective, is what this could mean for those who experience mental distress. It provides a much more expansive approach to respecting rights, will, and preferences.
Next steps
The team is now busy finalising the tools and resources based on community hui and preparing for Phase 2, Implementation at the two project sites.
In Phase 2, all tāngata whaiora who complete a MAPS will be invited to opt-in to the research project and participate in an interview to understand their experiences creating a MAPS and allow researchers to access their completed de-identified MAPS. The analysis will review the MAPS content, compare it to others, and better understand the core information to help improve education, resources, and awareness.
There will be an overlap between Phase 2 Implementation and Phase 3 Evaluation, beginning in October 2024. The goal of Phase 3 is to assess the effects of implementing and using MAPS on service- and individual-level outcomes and experiences from the perspectives of tāngata whaiora, whānau, family, kaimahi, and clinicians. This approach was chosen to gather the necessary information to evaluate the impact of MAPS on health, equity, social and cultural benefits, particularly for Māori.
We look forward to re-engaging with all of you soon and hearing about your experiences creating or using MAPS.
Ka kite me noho ora mai
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