First Nations mental health — structured clinical viva

Epidemiology, precisely. Te Rau Hinengaro (2003-2004, 12,992 adults including 2,595 Maori): among Maori, lifetime prevalence of any disorder 50.7%, 12-month 29.5%, 1-month 18.3%; commonest 12-month groups anxiety 19.4%, mood 11.4%, substance 8.6%; higher in women (33.6% versus 24.8%). The ethnic comparison: 29.5% Maori versus 19.3% Other — and after adjustment for age, sex, education, and household income, 23.9% versus 20.3%. The gap is largely carried by socioeconomic position, not ethnicity.^[1][2]

Assessment. Relationship before business via the Hui Process: mihi (proper greeting), whanaungatanga (connection before data), kaupapa (plain purpose), poroporoaki (deliberate closing). Then the standard history and risk assessment, plus whanau context and his strengths, with whanau involvement only with his consent.^[4]

Te Whare Tapa Wha as formulation scaffold. Four walls: taha tinana (physical), taha hinengaro (mental/emotional), taha whanau (family/social), taha wairua (spiritual). His withdrawal from whanau is a collapse of one wall that props the others. Present it as Durie's respected model — not a claim that every Maori patient is identical. Durie's strategies add the policy layer: secure cultural identity, participation, better services, workforce, autonomy and control.^[3][4]

Responding to "just another statistic." Validate, do not defend: he is describing a real, documented phenomenon — racism is associated with more negative healthcare experiences and reduced trust and use of services. Cultural safety is defined by him, not declared by me; my job is to make this episode of care measurably different and to say so plainly.^[5][6]

The trap to avoid. Quoting prevalence as ethnic vulnerability. The examiner who hears "Maori have high rates" without the SES attenuation and the determinants framing has just failed you.^[2][5]