Rapua Te Āhuru Mōwai

A kaupapa Māori mental health service pilot taking a different approach to care
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As Aotearoa New Zealand’s mental health law — the Mental Health Act — progresses towards change, we’ll be showcasing inspirational local and international initiatives that show just how successful non-forceful mental health care can be.  

Mental Health Foundation

One such ground-breaking initiative is Rapua Te Āhuru Mōwai, a mental health and addictions transitions pilot and action from the Aotearoa New Zealand Homelessness Action Plan. Rapua provides affordable, high-quality and sustainable housing to people living with serious mental illness and high and complex needs in Tāmaki Makaurau. It also offers a transition programme for people leaving acute mental health inpatient services, to ensure they receive housing, ongoing mental health and addiction and other wrap-around supports tailored to their individual needs.   

Rapua operates as a collaborative partnership between Te Toka Tumai (formerly Auckland DHB) clinical services, CORT (a community housing provider) and Mahitahi Trust (a kaupapa Māori organisation) to provide this support to people who would otherwise have nowhere to go after being discharged from an inpatient mental health unit.  

In its first three years, Rapua has fostered better, more independent living for 42 people with high and complex mental health needs. 

Getting Rapua off the ground

Alison Hudgell, General Manager at Mental Health and Addiction Services — Te Toka Tumai, tells us how it all started.

“We’d been talking with the (then) Ministry of Health about some challenges our adult acute mental health unit in Auckland was facing. We have had whaiora (people seeking wellness) who were, so to speak, ‘stranded’ in mental health units...We were really concerned about keeping people in for long stretches of time, longer than is needed.”  

Raewyn Allan, Tumu Whakarae (CEO) at Mahitahi Trust explains why keeping people in inpatient units for extended periods of time is such a big issue.  

“When our people become unwell, they often lose their housing as a consequence. This can lead to a vicious cycle of homelessness, becoming more unwell, then coming out of inpatient units with nowhere to go. We wanted to tighten up that loop.”  

The Ministry took note and helped Te Toka Tumai launch Rapua as part of the Housing Action Plan. Mahitahi and CORT, who already had a fruitful and long-standing relationship, quickly came on board. The three agencies have since been working together to support people with mental distress to live well and independently in their community, and avoid re-admission into acute services.   

Mental Health Foundation

Putting the person first

The people Rapua has helped were first identified within clinical mental health services, and, crucially, also provided input during the model’s co-design and development processes. A collective, whanaungatanga-based approach to reviewing whether this service will work for a person is what makes this pilot so different, points out Julia Aramoana, Service Manager at Mahitahi Trust.

' The main point of difference here, as I see it, is whānau getting a chance to learn about Rapua and ask any questions before committing to it. Building relationships and trust is a key part. We try to work out together if this is the right choice for them, even before getting the referral. '

– Julia Aramoana, Service Manager at Mahitahi Trust

It all comes down to choice and tino rangatiratanga (independence), because when a person gets a say in where they’re going to live, the chances for success are much higher. Raewyn Allan sums it up.  

“We keep looking until we find the whare that works for them. Same with the furniture. If they wanted a bright orange couch, then a bright orange couch it was,” she says. 

Providing support, through thick and thin

One of the Rapua model’s core philosophies is to house whānau in periods of wellness and unwellness alike, no matter what they’re going through. It’s something Raewyn Allan speaks of with unwavering belief.

' At some point, somebody has to put [an] advocacy stake in the ground and say, just because something has happened, it doesn’t mean that we’re not going to provide you with a whare and the support you need. We’re going to hang in there... We’re going to work through all that together. '

– Raewyn Allan, Tumu Whakarae (CEO) at Mahitahi Trust

Philippa Cope, Pouwhakahaere Matua — Director at Mahitahi, adds that reconnection is another priority for Rapua, too. Many people accessing services have been disconnected from their whānau and tamariki, so building these hononga (connections) back up is a priority for the team.  

Mental Health Foundation

Katie Ferguson, Service Clinical Director for Te Whetu Tawera Adult Acute Mental Health Unit, recounts the story of someone who, after decades of being seriously unwell, got significantly better in her early forties — so much so that she was finally able to engage with her whānau and tamariki again. CORT moved her into a two-bedroom house so her kids could stay with her.   

“She was also removed from the Mental Health Act, which would have been unheard of prior to this service being made available to her,” Katie says.   

At the beginning of the year, there was a whanaungatanga hui and barbecue at the beach between people engaged with Rapua and Mahitahi kaimahi. Julia Aramoana, who was new to the team at the time, couldn’t tell who was who. That's when she knew things were going really well.   

“The way whaiora were enjoying the water and socialising with each other, that told [me] more about their wellbeing than any report could capture. When we talk about reconnection, it’s also about reclaiming your mana motuhake and connecting with people who understand your world view,” Julia says. 

Reaping the results

The data leaves no room for doubt — Rapua’s model is working. People who have engaged with Rapua have seen a significant drop in their hospital readmission rates, and if they are re-admitted to hospital, are finding the time between their readmissions is getting longer and longer. Crucially, when someone is readmitted to hospital, the Mahitahi and CORT teams stay involved with them to uphold the person’s mana and ensure they retain their own whare (home).   

But it’s not just numbers that show the merit of Rapua; the pūrākau or anecdotal evidence is just as valuable to the team. Rapua kaimahi can see how this model can be life-changing for people with mental distress, with their whānau members often commenting things like, “That’s the most well they’ve been in a long time.”  

People who have engaged with Rapua now trust services more, including clinicians. And there’s hope, much more than there was before.   

 

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