Solution-Based Nursing: An Alternative Model for Assessing Psychosis and Mai Aitu in Mental Health

Abstract

The objective of this paper is to explore documented research and literature that describes the presenting clinical symptoms of Mai Aitu, and also to explore culturally attuned mental health frameworks that could be used to assess Pacific Islanders who present to mental health services in states of crisis.As a community mental health nurse in the Crisis Assessment and Treatment Team (CATT) I am confronted almost every day with the increasing number of Pacific Islanders presenting in crisis with symptoms consistent with the well documented signs of psychosis. For instance symptoms like hallucinations, delusion and paranoid ideation that are also well known for describing schizophrenia. My concern is that as mental health nurses we may be compromising our practice, the safety of our Pacific Island population and possibly the credibility of our profession with what appears like a lack of knowledge and awareness regarding the clinical symptoms of some Pacific Island mental illness. In Tonga it is called Avea Avanga, in Fiji it is referred to as Lilia, in Samoa it is known as Mai Aitu. The issue becomes apparent when Samoan clients present in crisis with what appears to be psychosis but the fanau believe their love one is not mentally unwell, that he or she is simply suffering a traditional Samoan illness. Therefore insist he or she be treated at home, instead of admission to the psychiatric hospital, and also be seen by a Samoan healer instead of a psychiatrist. An extensive literature search did not yield many credible evidence based documents, however there was some agreement and description of what Mai Aitu is. However none of the documents had good suggestions or evidence for how Mai Aitu should be treated or managed in Mental Health Services. There is an urgent need to conduct more research in order to ascertain evidence that describe the clinical symptoms of these Pacific mental illnesses. However this research should only be carried out by people with the appropriate ethnic back ground as I suspect a lot of this knowledge would not be written but simply passed down from one generation to another, congruent with Pacific philosophy. There also appears to be an association between the high numbers of Pacific people admitted with psychosis for the first time and this knowledge deficit. Considering this as a Samoan Mental Health Nurse I concluded that the use of Solution Focused Nursing as an interim measure may be a practical alternative for the assessment care and treatment of Pacific people. This paper explores this option as a helpful process for assessing Pacific Islanders who present to the Crisis Assessment and Treatment Team.