Doc #122 — Mental Health: National Grief and Social Purpose

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RECOMMENDED ACTIONS (BY URGENCY)

First week:

1. Include mental health in government communications from Day 1 — acknowledge the loss, acknowledge the grief, affirm that it is normal
2. Keep schools open as a priority — routine and community for children and families
3. Ensure marae, churches, and community halls are supported as gathering places

First month:

4. Begin training community volunteers in psychological first aid
5. Assess psychiatric medication stocks and begin managed tapering plans where appropriate
6. Establish community check-in systems for isolated individuals
7. Begin planning national memorial and remembrance framework

First year:

8. Establish peer support groups in communities
9. Ensure essential worker psychological support programs are functioning
10. First national day of remembrance
11. Support cultural expression — community art, writing, music, performance

Ongoing:

12. Regular assessment of population psychological health (structured community surveys, community reports)
13. Ongoing training of community mental health volunteers
14. Cultural and narrative development — supporting NZ’s emerging identity as a recovery society

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1. WHAT NZ’S POPULATION IS DEALING WITH

1.1 The scope of loss

NZ is one of the most internationally connected small countries in the world. As of the most recent census data, approximately 27% of NZ’s resident population was born overseas.² A large NZ diaspora lives abroad — an estimated 600,000–1 million NZers lived overseas pre-war, primarily in Australia, the UK, and North America.³

This means: A significant fraction of NZ’s population has close family members — parents, children, siblings, partners — in countries that may have been directly affected by nuclear strikes or their aftermath. The UK, which is likely among the hardest-hit nations in a NATO-Russia exchange, is home to one of the largest NZ diaspora communities.

For many NZers, the event means the probable death of people they love. Not confirmed death — probable death, which is in some ways harder to process because it forecloses neither hope nor grief.

For the immigrant population specifically, the loss may include not just people but an entire homeland, culture, and identity.

1.2 Ambiguous loss

The psychological literature identifies “ambiguous loss” — loss where there is no confirmation of death, no body, no closure — as particularly difficult to process.⁴ NZ’s situation is ambiguous loss at national scale. People will not know with certainty what happened to specific individuals overseas for months or years, if ever.

This ambiguity prolongs grief, complicates adaptation, and can produce persistent psychological distress that does not follow the normal grief trajectory. Standard models of bereavement (denial → anger → bargaining → depression → acceptance) are approximations even for individual loss; they do not reliably describe responses to ambiguous, collective, civilizational loss.

1.3 Loss beyond people

People will also grieve:

• The world they knew: International travel, cultural exchange, global commerce, the internet as a connective medium, the assumption of progress, the expectation that their children would have opportunities similar to their own
• Career and identity: Many people’s professional identities are tied to industries that no longer exist (international trade, tourism, finance, tech, entertainment, media)
• Material comfort: Living standards will decline. Familiar products disappear. Pleasures that were taken for granted (fresh coffee, new clothing, varied cuisine, entertainment options) are gone.
• Assumptions about the future: The fundamental assumption that tomorrow will be roughly like today — the psychological bedrock of normal life — is shattered

1.4 Uncertainty and anxiety

Beyond grief, the population faces radical uncertainty:

• Will the nuclear winter get worse? How long will it last?
• Will food remain sufficient? Will the power stay on?
• Is the government’s plan going to work?
• Will there be conflict, breakdown, or authoritarian overreach?
• What kind of life will my children have?

Sustained uncertainty is psychologically corrosive. It differs from acute fear (which is time-limited and energizing) in that it grinds away at functioning over months and years.

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2. PREDICTABLE PSYCHOLOGICAL RESPONSES

2.1 What to expect — not a clinical taxonomy

The following are common responses to collective catastrophe, documented across disaster psychology research.⁵ They are not disorders to be treated but normal responses to abnormal circumstances. The goal is not to eliminate these responses but to prevent them from becoming entrenched patterns that disable functioning.

Initial shock and disbelief (days to weeks): Numbness, difficulty processing information, going through motions automatically. This phase may actually facilitate compliance with early government directives — disaster research suggests that people in the acute shock phase are often compliant and cooperative rather than panicked.⁶

Surge of community solidarity (weeks to months): Disaster research consistently documents an initial period of intensified community cohesion — neighbors helping neighbors, strangers cooperating, social barriers temporarily lowered.⁷ This is a real and valuable resource but it is temporary. Policies and institutions that depend on sustained altruism without institutional support will fail when this phase ends.

Grief, anger, and depression (months to years): As the reality sinks in, grief for lost people, lost futures, and lost comfort becomes the dominant emotional landscape. Anger at the situation, at governments (both foreign governments who caused the war and the NZ government managing the aftermath), at perceived unfairness in rationing, at the universe. Depression — not necessarily clinical major depression, but persistent sadness, low motivation, difficulty finding meaning. This is the hardest phase for recovery efforts because it coincides with the hardest practical conditions (peak nuclear winter, peak consumable depletion).

Adaptation and new normal (years): Most people eventually adapt. They develop new routines, new identities, new sources of meaning. But “eventually” can mean years, and the adaptation is not uniform — some people adapt quickly, others slowly, some not at all. Substance use, domestic violence, social withdrawal, and suicide risk are elevated throughout this period and beyond.⁸

2.2 Who is most vulnerable

• People with pre-existing mental health conditions: Loss of medication (see Doc #116) compounds psychological stress. NZ has a significant population on psychiatric medication — abrupt withdrawal from SSRIs, benzodiazepines, and antipsychotics is medically dangerous and psychologically destabilizing.
• People who have lost family overseas: The ambiguous loss population — probably a majority of NZ’s residents.
• Recent immigrants with family in directly affected regions: Double burden of personal grief and loss of cultural homeland.
• Children and adolescents: Developing minds are particularly vulnerable to sustained stress and loss of normalcy. Schools are the frontline of child mental health support.
• People whose identity was tied to the old world: Professionals in industries that no longer exist, people whose sense of self was built around international connection, achievement in now-irrelevant domains, or consumer culture.
• First responders and essential workers: Decision fatigue, moral injury (making rationing decisions that affect lives), sustained stress without relief.
• Elderly people living alone: Social isolation compounds grief. Reduced mobility limits access to community support.

2.3 Substance use

NZ has existing alcohol production capability — wine (Marlborough, Hawke’s Bay, Central Otago), beer (numerous craft and industrial breweries), and spirits — and these industries may continue or expand. Alcohol becomes a coping mechanism for grief and stress. Increased alcohol consumption is a predictable consequence of the crisis, and it creates secondary problems: domestic violence, impaired work capacity, health burden, accidents.⁹

This is a tension: banning alcohol is impractical and arguably counterproductive (moderate social drinking has genuine community-building value; prohibition historically creates black markets and undermines compliance with other regulations¹⁰). But unrestricted alcohol consumption in a grieving, stressed population causes serious harm. Policy should be thoughtful — probably rationing and social norms rather than prohibition — but this document does not propose a specific alcohol policy. It flags the issue for governance planning (Doc #143–157).

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3. WHAT HELPS

3.1 Purpose and agency

The single most protective psychological factor in disaster recovery is the sense that one’s actions matter — that there is meaningful work to do and that doing it contributes to something larger than individual survival.¹¹

NZ’s recovery offers this in abundance. There are gasifiers to build, pastures to manage, skills to learn, children to teach, ships to sail, communities to organize. The practical demands of recovery are, paradoxically, psychologically beneficial — they provide structure, purpose, and the tangible experience of making things better.

Government communication (Doc #2) should emphasize agency and contribution, not just survival and endurance. “We need you” is more psychologically sustaining than “hang in there.”

3.2 Community connection

Social isolation is the strongest predictor of poor psychological outcomes after disaster.¹² NZ has an advantage here: it is a small country with relatively strong community structures, particularly in rural areas and Māori communities.¹³ Marae (over 700 nationwide), churches, sports clubs (Rugby, netball, and cricket clubs in virtually every town), schools, and community organisations such as the Rural Support Trusts and Citizens Advice Bureaux provide existing frameworks for connection.

Practical actions:

• Community gathering points maintained and supported (marae, community halls, churches, schools)
• Shared work (community gardens, building projects, food preservation) organized to create regular social contact
• Deliberate attention to people living alone — visiting systems, community meals, integration into work teams
• Schools remain open and functioning as community hubs for children and families

3.3 Honest, regular communication

Uncertainty is psychologically corrosive. Regular, honest communication from government (Doc #2) reduces uncertainty — not by pretending everything is fine, but by providing a reliable picture of what is known, what is being done, and what to expect.

The worst approach: Silence, followed by sudden bad news. This teaches people that no news means the government is hiding something, which maximizes both anxiety and distrust.

The best approach: Regular, scheduled, honest updates even when there is nothing new to report. Acknowledging uncertainty where it exists. Admitting mistakes. Treating the public as adults who can handle difficult information.

3.4 Ritual, ceremony, and collective grief

Human beings process loss through shared ritual. Funerals, memorials, days of remembrance — these are not luxuries. They serve a psychological function that has been recognized across every human culture for millennia.¹⁴

Specific recommendations:

• National days of remembrance established early — formal acknowledgment of what has been lost
• Community memorial practices supported — each community should be encouraged to develop its own forms of collective mourning and remembrance
• Māori tangi and hui protocols respected and supported — tangihanga (Māori mourning practice) may provide a cultural framework that benefits the broader community as well
• Ongoing ritual — not a single event but regular occasions for collective acknowledgment. Anniversaries, seasonal markers, community celebrations that include space for remembrance

3.5 Children’s needs

Children need:

• Routine: School, meals, bedtime, play — as much normalcy as possible within the new circumstances
• Honest, age-appropriate information: Children know something terrible has happened. They fill information vacuums with imagination, which is usually worse than reality. Simple, truthful, age-appropriate explanations are better than silence or false cheerfulness.
• Adult stability: Children are affected more by their caregivers’ emotional state than by the event itself. Supporting parents and teachers supports children.
• Agency: Even young children benefit from having responsibilities and feeling useful. Age-appropriate contributions to family and community life.
• Play: Unstructured play is how children process stress. It should not be displaced by “useful” activity.

3.6 Meaning-making

In the longer term, NZ’s psychological recovery depends on developing a shared narrative about what happened, what NZ is doing about it, and what kind of society NZ is becoming. This is not something the government can dictate — it emerges from community dialogue, cultural expression, spiritual practice, and lived experience.

What government can do:

• Create space for cultural expression (support artists, writers, musicians — not as luxury but as psychological infrastructure)
• Not impose a single “official narrative” — allow diverse perspectives and expressions of grief, anger, hope, and meaning
• Frame the recovery effort in terms of purpose and legacy, not just survival: “We are building something” rather than “We are enduring something”

What communities do themselves:

• Develop their own stories, rituals, and practices
• Religious and spiritual communities provide frameworks of meaning for their members
• Māori communities draw on whakapapa (genealogy), wairuatanga (spirituality), and collective identity
• New cultural forms emerge — art, music, storytelling, humor (humor is a critical coping mechanism and should not be suppressed or judged)

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4. WHAT THE MENTAL HEALTH SYSTEM LOOKS LIKE

4.1 Professional capacity

NZ has approximately 500–700 psychiatrists and 3,500–4,500 registered psychologists, plus counsellors, social workers, and mental health nurses.¹⁵ This workforce is concentrated in Auckland, Wellington, and Christchurch, with significant gaps in rural and provincial areas. This is inadequate for a population-wide mental health crisis even under normal conditions — and under recovery conditions, some of these professionals are themselves affected, some may leave (or attempt to), and pharmaceutical support for psychiatric conditions is limited (Doc #116).

Honest assessment: Professional mental health services can provide support to the most severely affected — people with pre-existing conditions, those experiencing psychotic episodes, acute suicidal crises. They cannot provide individual therapy to the entire population. The bulk of psychological support must come from community, social structure, and the non-clinical interventions described in Section 3.

4.2 Community-based support

The practical model is a stepped approach:

Level 1 — Universal (everyone): Purpose, community, routine, honest communication, ritual, agency. These are the foundations and they serve the entire population. Most people will cope adequately with these supports and time.

Level 2 — Targeted (those struggling): Peer support groups, community check-in systems, trained community volunteers who can provide basic psychological first aid (listening, normalizing, connecting to resources). Training community volunteers in psychological first aid is a high-value investment — it multiplies the reach of the professional workforce.¹⁶

Level 3 — Specialist (severe distress): Professional mental health services for people with pre-existing conditions, acute crises, trauma responses that are not resolving, substance dependence, suicidal ideation. Triage and prioritisation will be necessary. NZ’s existing mental health legislation — the Mental Health (Compulsory Assessment and Treatment) Act 1992 — provides a legal framework for compulsory treatment in acute cases, but its practical application under recovery conditions (reduced inpatient capacity, limited medication) will need adaptation.¹⁷

4.3 Psychiatric medication

NZ’s stock of psychiatric medications is finite and cannot be locally produced for the foreseeable future (Doc #116). Key concerns:

• SSRI/SNRI tapering: Abrupt withdrawal from antidepressants causes discontinuation syndrome — potentially severe and debilitating. Managed tapering (dose reduction over weeks to months) is strongly preferable to running out suddenly. Rationing plans should account for tapering, not just extend supply by reducing doses.
• Benzodiazepines: Abrupt withdrawal is medically dangerous (seizure risk). Managed tapering is essential.
• Antipsychotics: Discontinuation in people with schizophrenia or bipolar disorder risks relapse, which in a crisis environment may be very difficult to manage. These patients are among the highest priority for ongoing medication.
• ADHD medications: Lower risk on discontinuation but significant impact on functioning for affected individuals.

Medical professionals should begin planning for pharmaceutical depletion as soon as stock levels are assessed (Doc #116). Early, managed transitions are far better than crisis withdrawals.

Withdrawal triage protocol. When psychiatric medication stocks decline to the point where not all patients can continue at therapeutic doses, allocation decisions must be made. The guiding principle is the same as across the Recovery Library: maximise stability, reduce suffering, support recovery. In practice, this means:

1. Highest priority for continued medication: Patients whose discontinuation poses acute safety risks — those with schizophrenia or severe bipolar disorder where medication withdrawal risks psychotic episodes, and those on benzodiazepines where abrupt withdrawal risks seizures. These patients receive medication longest.
2. Managed tapering for moderate-risk patients: Patients on SSRIs/SNRIs for depression and anxiety. Discontinuation syndrome is unpleasant and debilitating but not typically life-threatening. These patients receive a structured tapering plan — dose reduction over weeks to months — rather than abrupt cessation. The tapering schedule should be published by the National Pharmaceutical Triage Authority (Doc #116) so that all prescribers follow the same protocol.
3. Early transition for lower-risk patients: Patients on ADHD medications, sleep medications, or mild anxiolytics where non-pharmacological alternatives exist — though these alternatives are generally less effective. For ADHD, behavioural strategies and structured environments partially compensate for medication but do not replicate the cognitive performance gains of stimulant medication; for insomnia, sleep hygiene and relaxation techniques help but typically produce slower and less reliable results than pharmacotherapy.¹⁸ These patients transition to non-pharmacological support (community-based counselling, structured activity, peer support) with clinical monitoring.
4. Non-pharmacological investment is essential. The withdrawal triage protocol only works if the community mental health support system (Section 4) is functioning. Removing medications without providing alternative support is abandonment. The two must be developed together — community mental health capacity must expand in parallel with pharmaceutical tapering.
5. Transparent communication. Patients must understand why their medication is being reduced, what the plan is, and what support is available. Unexplained medication changes in a crisis environment will be experienced as abandonment and will undermine the trust on which the entire mental health response depends.

4.4 Suicide prevention

Suicide risk is elevated in the aftermath of catastrophe, particularly among people who have lost family, lost purpose, or lost access to psychiatric medication. NZ’s pre-existing suicide rate is approximately 11–13 per 100,000 population per year — above the OECD average, with disproportionately high rates among young men (15–24), Māori (roughly twice the non-Māori rate), and rural populations.¹⁹

Practical approaches:

• Community connectedness (Section 3.2) is the strongest protective factor
• Regular contact systems for people living alone or identified as vulnerable
• Lethal means restriction where feasible (NZ’s Arms Act 1983 and post-2019 amendments already provide a restrictive firearm regime; enforcement under emergency conditions may require additional coordination with NZ Police)
• Training community members in recognizing and responding to suicidal distress
• Professional services reserved for highest-risk individuals
• Cultural approaches: Māori suicide prevention frameworks that address wairua (spirit), whānau (family), and community belonging

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5. SPECIFIC POPULATION GROUPS

5.1 Māori

Māori communities have cultural resources for processing collective grief and loss that predate European contact — tangihanga, karakia, whanaungatanga, connection to whenua (land). These are not abstract traditions — they are living practices with demonstrated psychological value.²⁰

Recommendation: Support Māori communities in responding to the crisis through their own tikanga (customs). Resource marae as community mental health infrastructure. Ensure Māori mental health professionals are supported and connected. Do not impose pākehā models of grief or mental health on Māori communities.

Specific concerns: Māori are disproportionately represented in NZ’s mental health statistics and are at higher baseline risk for suicide. The crisis compounds existing inequities. Adequate resource allocation to Māori mental health support is an equity issue.

5.2 Pasifika communities

Pacific Island communities in NZ are tightly connected to families in the Pacific. The fate of Pacific nations — many of which have extremely limited resources and will struggle under nuclear winter conditions — is of acute concern. NZ has humanitarian obligations to the Pacific (Docs #153–155) and the outcome of those obligations directly affects the psychological state of NZ’s Pasifika population.

Cultural practices of collective mourning, church-based community, and extended family support provide protective frameworks.

5.3 Recent immigrants

NZ’s immigrant population from East Asia, South Asia, Europe, and elsewhere faces the loss of homelands that may have been directly affected. Language barriers may limit access to support services. Cultural norms around grief expression vary. Immigrant community organizations and religious institutions are the primary support channel.

5.4 Essential workers and decision-makers

People who are managing the crisis — government officials, medical professionals, infrastructure workers, military/civil defence — face a specific kind of psychological burden: moral injury from making decisions that affect lives (who gets medication, which regions get resources, when to stop treating a patient), exhaustion from sustained high-demand work, and guilt about their own relative privilege (essential workers may receive better rations, housing, or protection).

Support for this group includes: Regular rotation and rest where possible (constrained by the limited number of qualified replacements — particularly acute for medical and engineering specialists), peer support among colleagues, explicit acknowledgment that the decisions they make are difficult and that imperfect outcomes are expected, and access to professional support.

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6. LONG-TERM TRAJECTORY

6.1 The first 2 years

The hardest period. Peak nuclear winter, peak resource scarcity, peak grief. Psychological distress is widespread and normal. The goal is not to eliminate distress but to maintain functioning — people going to work, communities cooperating, institutions operating — despite distress.

6.2 Years 2–5

Adaptation for most people. New routines, new identities, new sources of satisfaction and meaning. Grief doesn’t disappear but becomes integrated into life rather than dominating it. Some people remain stuck — persistent depression, substance dependence, social withdrawal — and need continued support.

6.3 Years 5+

A new normal. Children born after the event grow up in this world as their baseline. NZ’s culture and identity evolve to incorporate the catastrophe as a foundational event — analogous to how WWII shaped the identity of nations for generations. The question becomes not “how do we cope” but “what kind of society are we building.”

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7. WHAT THIS DOCUMENT DOES NOT COVER

• Clinical psychiatric treatment protocols (standard medical references)
• Detailed substance abuse treatment programs
• Specific school curriculum for psychosocial support (Doc #158)
• Trauma therapy techniques (these require trained therapists and are not scalable to the whole population)
• Policy recommendations for alcohol and drug regulation (governance, Docs #146–157)

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1. Stats NZ, “National population estimates: At 30 June 2024.” https://www.stats.govt.nz/information-releases/national-p... — NZ’s estimated resident population was approximately 5.2 million in 2024; range reflects census projection uncertainty.↩︎

2. Stats NZ, “2018 Census population and dwelling counts.” https://www.stats.govt.nz/information-releases/2018-censu... — Approximately 27.4% of NZ’s usually resident population was born overseas at the 2018 Census. This percentage may have changed since.↩︎

3. NZ diaspora estimates vary. Stats NZ and MFAT have published various estimates. The 600,000–1 million range is commonly cited but uncertain due to the difficulty of counting emigrants.↩︎

4. Boss, P. (2006), “Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss,” W.W. Norton & Company. The foundational academic work on ambiguous loss.↩︎

5. Disaster psychology overview: Norris, F.H. et al. (2002), “60,000 Disaster Victims Speak: Part I. An Empirical Review of the Empirical Literature, 1981–2001,” Psychiatry, 65(3), 207–239.↩︎

6. Quarantelli, E.L. (2008), “Conventional Beliefs and Counterintuitive Realities,” Social Research, 75(3), 873–904. Panic is rare in disasters; compliance and cooperative behaviour are the norm in the acute phase.↩︎

7. Post-disaster community solidarity: Solnit, R. (2009), “A Paradise Built in Hell: The Extraordinary Communities That Arise in Disaster,” Penguin. Documents the consistent emergence of mutual aid and community solidarity in the immediate aftermath of disasters.↩︎

8. Post-disaster substance use and violence: Substance Abuse and Mental Health Services Administration (SAMHSA), various publications on disaster behavioral health. https://www.samhsa.gov/disaster-preparedness — For NZ-specific alcohol harm data, see the Health Promotion Agency / Te Hiringa Hauora, “Alcohol in New Zealand” fact sheets, and the Canterbury earthquake research: Beaglehole, B. et al. (2015), “Psychological distress and use of alcohol following the Canterbury earthquakes,” NZ Medical Journal, 128(1425).↩︎

9. Post-disaster increases in alcohol consumption and domestic violence are well-documented. For NZ context: Alcohol Healthwatch (2013), “Alcohol and Disasters.” For international evidence: Nordløkken, A. et al. (2013), “Changes in alcohol consumption after a natural disaster,” BMC Public Health, 13, 58.↩︎

10. NZ’s own prohibition referendum history (1911–1919) illustrates the practical difficulties. See Grigg, A.R. (1992), “Prohibition and Women: The Preservation of an Ideal and a Myth,” NZ Journal of History, 26(2).↩︎

11. Purpose and agency as protective factors: Frankl, V.E. (1946/1984), “Man’s Search for Meaning,” Beacon Press. Also: Antonovsky, A. (1979), “Health, Stress, and Coping,” Jossey-Bass (sense of coherence model).↩︎

12. Social isolation and post-disaster outcomes: Kawachi, I. and Berkman, L.F. (2001), “Social ties and mental health,” Journal of Urban Health, 78(3), 458–467.↩︎

13. NZ’s social capital and community connectedness are documented in the Ministry of Social Development’s “Social Report” series, most recently “The Social Report 2016 — Te pūrongo oranga tangata.”↩︎

14. Role of ritual in grief processing: Romanoff, B.D. and Terenzio, M. (1998), “Rituals and the grieving process,” Death Studies, 22(8), 697–711.↩︎

15. NZ mental health workforce data from the Medical Council, NZ Psychologists Board, and Ministry of Health workforce reports. Numbers are approximate and should be verified against current registration data.↩︎

16. Psychological First Aid: WHO (2011), “Psychological First Aid: Guide for Field Workers.” https://www.who.int/publications/i/item/9789241548205 — A widely used, evidence-based approach to immediate psychological support that can be taught to non-professionals.↩︎

17. Mental Health (Compulsory Assessment and Treatment) Act 1992, NZ Legislation. https://www.legislation.govt.nz/act/public/1992/0046/late...↩︎

18. National Institute for Health and Care Excellence (NICE), Guideline NG87 (2018), “Attention deficit hyperactivity disorder: diagnosis and management.” Non-pharmacological interventions for ADHD are rated as adjunctive rather than equivalent to medication in most clinical guidelines.↩︎

19. NZ suicide statistics: Ministry of Health / Manatū Hauora and the Chief Coroner’s annual provisional suicide statistics. https://www.health.govt.nz/publication/suicide-facts↩︎

20. Māori mental health and cultural approaches: Durie, M. (1999), “Te Pae Mahutonga: a model for Māori health promotion,” Health Promotion Forum of New Zealand Newsletter 49.↩︎