Pacific Consumer 'Tiare Ruperupe' - Network North

Pacific Consumer ‘Tiare Ruperupe’
Leadership Framework
for the Mental Health & Addictions Sector
March 2010

Sponsored by
The Northern District Health Board Support Agency & Moana Pasifika on behalf of the Northern Region
District Health Boards & the Network North Coalition
Prepared by
Tuiloma Lina Samu & Tai Richard
Pacific Consumer ‘Tiare Ruperupe’ Leadership Framework for the
Mental Health & Addictions Sector
“Pacific consumer leadership is about using one’s skills and experience to act and/or advocate
passionately on behalf of Pacific consumers, tangata whaiora, service users and their families to
realize their potential by ensuring that their needs are being met through influencing and optimizing
service delivery and systems processes in the mental health and addictions sector and in other
areas of society”
Acknowledgements
We are honoured and privileged to have had the opportunity to undertake this innovative piece of work.
There are many people to thank, whose collective passion and vision for the health and wellbeing of
Pacific consumers and their families provided the impetus to embark on this incredible journey.
The work of Papali’i Seuili Johnny Siaosi, behind-the-scenes and often beyond the call of duty, is
well known among Pacific mental health and addictions circles. Thank you chief for enthusiasm and
unrelenting drive in your role as consumer advisor, matua and trainer.We also acknowledge Takanga A
Fohe (Pacific Mental Health and Addictions Service) and Waitemata DHB for creating and allowing the
space to progress Pacific consumer initiatives.
We applaud the courage of the Moana Pasifika Project Steering Group and NDSA, for commissioning this
piece of research. We pay tribute to our friends, matua, staff and colleagues in the mental health and
addictions sector, who work tirelessly and often with little acknowledgement.
Finally our deepest gratitude to all the Pacific consumers, family members and young people we met,
for welcoming us into your lives and enriching ours with your courage, perseverance, mana, resilience,
passion and optimism. To you all, we could not have done it without your expertise, patience and
guidance; we are sincerely grateful. Our humblest apologies to those we may have inadvertently missed
but know that you are an important part of this journey as well.
About the title:
Fa’afetai lava, fakaaue lahi, malo aupito, meitaki ma’ata,
vinaka vaka levu.
‘Tiare Ruperupe’ is a Cook Islands Maori term; ‘tiare’ meaning flower and ‘ruperupe’ can be translated as
flourishing or growing beautifully.
Citation: Pacific Consumer “Tiare Ruperupe” Leadership Framework
For the Mental Health & Addictions Sector
Published in 2010 by the Northern DHB support Agency Ltd
PO Box 112147, Penrose, Auckland, New Zealand
This document is available on the Network North Coalition website
http://networknorth.org.nz
Disclaimer:
This Framework has been developed from the stakeholder constituency of the Regional Pacific Mental Health &
Addiction forum, Moana Pasifika, and therefore any or all of the views expressed are not necessarily shared by the
NDSA, the Network North Coalition, or Northern region DHBs.
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Table of Contents Page
Executive Summary 5
1. Introduction
1.1 Project goal and deliverables 10
1.3 Methodology 10
1.4 Alignment with other NDSA-commissioned work 12
2. Literature Review
2.1 Consumer leadership development 13
2.2 The service-user workforce 18
2.3 Defining leadership 25
2.4 Leadership development frameworks & initiatives 29
3. Key informant interviews & focus group discussions
3.1 Defining Pacific Leadership 39
3.2 Barriers and gaps 42
3.3 Pacific consumer leadership: some key areas 47
4. Pacific Consumer Tiare Ruperupe Leadership Framework
4.1 Overview 53
4.2 Tiare Ruperupe 54
4.3 The Framework (Tumu) 56
5. Conclusion and Recommendations
5.1 Timeframes and level of implementation 62
5.2 Monitoring & Performance Indicators 63
5.3 Recommendations 63
6. Appendices
Appendix 1 - References 65
Appendix 2 - Participating Organisations 67
Appendix 3 - Stakeholder Consultation Information 68
Appendix 4 - NHS Leadership Qualities Framwork (UK) 73
Appendix 5 - Overview of Reccommendations 75

List of Figures page
Figure 1: Alignment of NDSA commissioned projects 12
Figure 2: Arnstein’s Ladder of Participation (1969) 15
Figure 3: Description of Arnstein’s Ladder of Participation 16
Figure 4: Consumer Advisor Role Competencies 22
Figure 5: Proposed 4C model adapted from Mariner’s 3C model 28
Figure 6: Midlands Leadership Framework 29
Figure 7: Excelerator Leadership Development Framework 31
Figure 8: NHS Leadership Qualities Framework 32
Figure 9: Centre for Excellence in Leadership (UK) Framework 33
Figure 10: Leadership Qualities Framework Quadrant 34
Figure11: Cultural and technical balance with lived experience 39
Figure 12: A key informant view on current service delivery model 43
Figure 13: A key informant view on a consumer and family-centred 44
service delivery model
Figure 14: 3D version of the 4C model 52
Figure 15: The Tiare Ruperupe Model – Part 1 Tiare 54
Figure 16: NHS Leadership Qualities framework 73
List of Tables
Table 1: Pacific consumer-specific workforce 18
Table 2: Levels of Leadership Participation 26
Table 3: DHBNZ Leadership Competencies 30
Table 4: Summary of selected leadership training programmes 35
Table 55: Pacific Consumer Leadership Development 57
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Executive Summary
There is increasing recognition that people with experience of mental
illness are an important component of effective service design and
delivery. The potential contribution this group has to the mental
health and addiction workforce is enormous, yet remains largely
under utilized.
While there appears to be a commitment to consumer-driven
initiatives, the limited participation and involvement of consumers
in strategic positions of influence and leadership may suggest
otherwise. For Pacific consumers, the lack of representation at senior
level is even more apparent when compared with their peers.
A predominantly young and fast-growing group, Pacific peoples
comprise approximately 7% of the total New Zealand population [1] .
As it is probable that the demand for appropriate mental health
and addictions services for Pacific peoples will continue to grow it
is imperative that the leadership capacity of Pacific consumers is
enhanced to further support the services that will effectively meet
their needs.
The Northern District Health Board Support Agency, in conjunction
with Moana Pasifika commissioned this research, to address these
issues.
This project is aimed at developing a Pacific Consumer Leadership
Framework for the mental health and addictions sector. It is
envisaged that the Framework will assist with developing, growing
and strengthening Pacific consumer participation and leadership in
all areas of the sector from policy development to service design and
delivery.
To achieve this, the following deliverables were identified
• A brief review of relevant literature and documentation
• The identification of existing consumer leadership frameworks
• The identification of relevant local, regional and national initiatives
• Appropriate consultation with key stakeholders through focus
• groups and interviews
• The development of a draft consumer leadership framework that is
available for consultation
• A final report with recommendations to be considered by key
stakeholders pertinent to this project
The primary means of data collection involved a brief review of
related literature, and interviews and focus group discussions
with key informants and stakeholder groups. A further source of
information was drawn from the experiences of the authors as
former mental health service users with substantial management and
governance experience.
[1] Statistics New Zealand 2006

The literature shows widespread acknowledgment of the important
role consumers play in service planning and delivery, and the value
of their contribution to the mental health and addictions workforce. A
key component of workforce development is leadership, and growing
and strengthening leaders within this cohort is essential.
The lack of genuine sector and provider commitment, and stigma
were identified as significant barriers for realizing consumer
leadership potential. While a number of leadership programmes and
workforce initiatives, both Pacific and mainstream, have existed for
some time, it remains inconclusive after this literature review, as to
why Pacific consumer participation in such programmes is a rarity.
The literature search yielded numerous examples of leadership
frameworks and training programmes both locally and internationally.
Finally the literature acknowledges that leadership development
takes time and requires adequate and appropriate resources.
A valuable source of information was gained from interviews and
focus group discussions with key stakeholders including Pacific
consumers and families, Pacific mental health and/or addiction
service providers, funders and others. The key areas explored during
the consultation process addressed the following topics:
• A definition of Pacific consumer leadership
• Pacific consumer participation in the mental health and addiction
sector particularly at senior level
• The benefits of Pacific consumer leadership to the sector
• Existing Pacific consumer leadership development initiatives
• Gaps in Pacific consumer leadership
• Key success factors in a leadership development framework for
Pacific consumers
The feedback from stakeholder consultations and the findings from
the literature review informed the development of the Framework.
The Framework is designed to consider as wide and broad a scope
of consumer experience, level of wellness and capabilities within
the mental health and addictions sector as possible. Some degree of
flexibility and fluidity however must be employed in its interpretation
and implementation.
The Tiare Ruperupe (flourishing flower) leadership model is contained
within two parts: the first, the tiare or flower, provides a bird’s eye
view guide that sits above or precedes the second part, the tumu
or stem, which is a more detailed, individualised description of the
Framework.
The Framework is underpinned by the core Pacific values and cultural
beliefs and practices.
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Recommendations
The following recommendations are made based on the findings
from the literature review and stakeholder consultations. It is
recommended that:
• The Framework be adopted and incorporated into key strategic
and policy documents and that further planning, funding,
contracting and delivery of mental health and addictions services is
undertaken in accordance with this Framework
• Pacific consumer workforce development is prioritised and
explicitly stated in key workforce development plans and
documents
• Pacific leadership initiatives and workforce development, as
guided by the Framework and other key policy documents, are
aligned and consistent regionally and at national level
• A follow-up phase and further development of the Framework
is undertaken. This phase could involve the development of
key indicators and outcome measures, a resource kit and the
implementation of a pilot programme to gauge its effectiveness
• Scholarships or places in current Pacific leadership training
programmes are created for Pacific consumers and that emerging
Pacific consumer leaders who participate in such programmes
receive appropriate supervision and mentorship
• A needs assessment and/or stock-take of the Pacific consumer
workforce and profile in Aotearoa New Zealand is undertaken
• A Pacific-specific peer support, consumer advisor training and a
bridging leadership training programme for Pacific consumers is
developed and implemented by Pacific for Pacific
• A specific Pacific training package is developed to imbed Pacific
peer support philosophy within the workforce and to train and
employ specific Pacific consumer auditors to maximize service
improvements
• A segment or module on Pacific consumer leadership be included
in existing and future Pacific and non-Pacific leadership training
courses within the sector
• Current management practices and service structures are
re-configured to ensure Pacific consumer advisors sit alongside
their managing peers and other advisors;
• More by-Pacific-consumer-for-Pacific research initiatives are funded
and resourced adequately
• A review of current mental health stigma-reduction and awarenessraising
marketing strategies and its effectiveness in getting the
message across to Pacific communities is undertaken
• A cost-benefit analysis of return-on-investment on projects such as
the present one is conducted
• A National Pacific Recovery Conference is held yearly and hosted
rotationally by each region
• Financial sustainability to develop the four regional and national
Pacific Consumer and Family Forums is ensured

1. Introduction
There is increasing recognition that people with experience of
mental illness are an important component of effective service design
and delivery. The potential contribution this group has to the
mental health and addiction workforce is enormous, yet remains
largely under utilized.
While there appears to be a commitment to consumer-driven
initiatives, the limited participation and involvement of consumers in
strategic positions of influence and leadership may suggest
otherwise. [2] For Pacific consumers, the lack of representation at
senior level is even more apparent when compared with their peers.
Effective leadership plays a crucial role in workforce development,
organizational infrastructure and effective service delivery according
to several key publications and policy documents [3] . There are
increasing calls for more consumer input into service design and
delivery in order to improve service delivery within the mental health
and addictions sector [4] . However, while many parts of the sector
have shown significant leadership growth, the same cannot be said
for Pacific consumers.
Pacific peoples experience high levels of mental illness and addictions
compared with others and despite their high needs they are less
likely to seek help from services. In most cases, when Pacific peoples
eventually present to mental health and addictions services they do
so in a state of severe un-wellness with complex needs which can be
costly to the sector. [5]
In addition, while empirical evidence is yet to surface proving
otherwise, it can be assumed that Pacific consumers will generally
experience poorer health and education, lower socio-economic
status and sub-standard housing compared to other New Zealanders,
perhaps to an even greater extent with the added burden of lived
mental illness and/or addiction experience.
Production of this Framework therefore is a timely exercise and
particularly significant to the sector given the fast-growing and
youthful nature of this population group. [6] As it is probable that
the demand for appropriate mental health and addictions services
for Pacific peoples will continue to grow it is imperative that the
leadership capacity of Pacific consumers is enhanced to further
support the services that will effectively meet their needs.
[2] Mental Health Commission, 2005
[3] CMDHB, 2008; Annandale & Richard, 2007; Minister of Health, 2006; Ministry of Health, 2005; Ministry of Health,
2004; Ministry of Health, 2002
[4] Mental Health Commission, 2005
[5] Oakley Browne, Wells & Scott, 2006, p179
[6] Statistics New Zealand, 2006

1.1 Project goal and deliverables
This project is aimed at developing a Pacific Consumer Leadership
Framework (the Framework) for the mental health and addictions
sector. It is envisaged that the Framework will assist with developing,
growing and strengthening Pacific consumer participation and
leadership in all areas of the sector from policy development to
service design and delivery.
To achieve this, the following deliverables were identified:
• A brief review of relevant literature and documentation
• The identification of existing consumer leadership frameworks
• The identification of relevant local, regional and national initiatives
• Appropriate consultation with key stakeholders through focus
groups and interviews
• The development of a draft consumer leadership framework that is
available for consultation
• A final report with recommendations to be considered by key
stakeholders pertinent to this project
1.2 Methodology
The principle means of data collection involved a brief review of
relevant literature as well as interviews and focus groups with key
stakeholders [7] .
Over 50 participants were involved including three consumer and
family focus group discussions (two in Auckland, one in Wellington),
a feedback session with the Auckland regional stakeholder group,
a focus group with Pacific providers both NGO and DHB, and Pacific
youth consumers. Key informant interviews were conducted with
clinicians, cultural advisors/matua, Child Adolescent Mental Health
Services (CAMHS), managers, funders, policy makers and researchers,
as well as other key personnel.
[7] See Appendix 2 for list of participants and participating organizations
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1.2.1 Document review
Relevant documents, reports and articles were identified in
conjunction with the Northern Districts District Health Boards
Support Agency (NDSA), Moana Pasifika and the Project
Steering Group members and obtained through searches
of key online databases, government websites,
non-government organisations (NGO), District Health Boards
(DHB) and the NDSA sources as well as personal
librarycollections. Initial searches yielded no information
relating pecifically to Pacific consumer leadership and/or
related framework or consumer leadership frameworks. Many
of the documents reviewed discussed mainstream leadership
theory both within the sector and beyond.
1.2.2 Stakeholder consultations
A similar collaborative process was utilized to identify and
recruit key stakeholders to participate in key informant
interviews and focus group discussions. Participants were
sent an information sheet prior to an interview or focus group
session, with those involved in one-on-one interviews receiving
the questionnaire beforehand. Feedback from interviews and
group discussions were either audio-recorded and/or
handwritten.
1.2.3 Authors’ experience
A third source of information is drawn from the lived mental
illness experiences of the authors of this report who are both
of Pacific descent with comprehensive backgrounds in research,
governance, policy, strategic leadership and management.
While this practice might seem at odds with Western scientific
research principles, the researchers as the first paradigm,
whereby the researchers’ experience and values will have some
influence and thus shape the research somewhat, suggests that
such approaches from a Pacific ideology at least, are both
meaningful and valid. [8]
1.2.4 Discussion document
Following the initial consultation stage an early version of the
Framework was developed as a discussion document and
distributed among key stakeholders. The additional feedback
provided the basis for refining and producing the final
Framework.
[8] Mitaera (1997, cited in Koloto, 2003)

Figure 1: Alignment of NDSA commissioned projects
Pacific consumer
leadership framework
Service user leadership &
workforce development
1.3 Alignment with other NDSA-commissioned work
The Pacific Consumer Leadership Framework is one of three projects
simultaneously commissioned by the NDSA. The other two projects,
which were completed by Health & Safety Developments, are The
Regional Pacific Model of Care and Regional Pacific Mental Health
and Addictions Service Framework, and Mental health and addictions
Pacific cultural practice for the Auckland Region.
All three projects while individually distinct are strongly aligned with
many overlapping characteristics whereby one is enhanced either
directly or indirectly by the other and vice versa. Each project has key
components of the mental health and addictions spectrum with all
aimed at improving mental health and addictions services for Pacific
peoples.
Effective services for
Pacific peoples
Regional Pacific
model of care &
Pacific mental health
and addiction service
framework
Service delivery, policy,
funding systems
Mental health and
addictions Pacific
cultural practice
Staff/workforce
development and practice
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2. Literature Review
The literature review collated key documents, research, and reports
to help inform the development of a Pacific Consumer Leadership
Framework in Aotearoa, New Zealand. In the majority of mental
health and addictions sector published reports there has been a
commitment to the recognition of consumers/ service users/ tangata
whaiora/ tangata motuhake [9] and a re-direction to focus services
on recovery principles. The initial search established that there is no
literature in New Zealand that primarily discusses Pacific consumer
leadership.
The main purpose of the document review was to provide
background information and rationale to address the key objectives
of the project. The review therefore is framed by the following broad
questions including:
• What is Pacific consumer leadership?
• What are some of the key issues for growing Pacific leadership?
• What are the key components of a Pacific consumer leadership
framework?
• How should this framework be implemented?
2.1 Consumer leadership development
There has long been a tension about consumer involvement in
the planning and determination of mental health and addictions
services and systems from the outset. The complaints of consumers/
service users have been well-documented with regards to stigma
and discrimination experienced after having a lived experience of
a mental illness, not only from wider society as a whole, but from
those working in the system that is meant to help people in their
recovery. [10]
The literature shows that Pacific consumers have a double stigma to
deal with: discrimination against having lived experience of a mental
illness and/or addiction as well as racial discrimination. [11] This is a
key topic as we look to how service users may often be overlooked
because of the entrenched power bases that determine who are
treated in token ways, who are taken seriously and who are being
listened to more than others when it comes to finding long-term
solutions for members of society, who are traditionally disempowered
or who have very little voice. [12]
There are many examples that assert that the involvement of
consumers in the planning of mental health and addictions services
is a crucial factor in service improvement, [13] but there is very little to
guide the sector on how to do this effectively.
[9] Māori term for people seeking wellness; mental health and/or service user
[10] Hansen, 2003
[11] ibid
[12] Arnstein, 1969
[13] Mental Health Commission, April 2007 & June 2004

[14] Mental Health Commission, June 2004
[15] Ministry of Health, February 2008
[16] Statistics New Zealand, 2006
[17] Mental Health Commission, May 2002
Much has also been said about the importance of focusing on
increasing access for Pacific people in mental health and addictions
services but again there is no effective guide to inform the sector
about the how.
2.1.1 Consumerism
In this report, a consumer is defined as a person who uses,
or who has used, mental health and/ or addictions services.
This termis used particularly in Western countries in which a
medico-legal psychiatric-based system determines mental
health delivery. Within New Zealand, the term service user has
become more accepted. The Te Reo M ori terms tangata
whaiora or person/ people who seek wellness and more lately
tangata motuhake or person/ people who live in
self-determination, are descriptions that more service users in
New Zealand are comfortable in using about their lived
experiences of a mental illness and their journeys towards their
recovery. [14] In this report these terms are used interchangeably.
2.1.2 Defining ‘Pacific’
Pacific is an homogenous term that describes migrants and
their descendents from the South Pacific island nations,
particularly the Cook Islands, Niue, Tokelau, the Kingdom of
Tonga, Fiji, Samoa, Tuvalu and to a lesser extent others such as
Tahiti, Kiribati and the Solomon Islands. [15] A predominantly
young and fast-growing group, Pacific peoples comprise
approximately 7% of the total New Zealand population .[16] .
However while there are similarities between these island
groups, there is also much diversity that uniquely differentiates
one from the other. For the purposes of this project, the term
Pacific consumers/services users refers to individuals who
identify primarily with one or more of the island groups
described above and others not mentioned who have previously
or currently access mental health and/or addictions services.
2.1.3 Consumer development & empowerment
Consumers have been largely disempowered throughout the
history of mental health services delivery. The consumer
movement has been a means for those who have
experienced mental illness to assert their rights and find a
voice to challenge and change the parts of the system that
are not working, to help in their recovery. It is also a
mechanism whereby consumers have been able to stand
in their own power in an industry where they have been too
often ignored. [17]
The catchphrase of the international consumer movement is “nothing
about us without us”. The consumer movement in New Zealand has
adopted this mantra. The beginning of the relatively young New
Zealand consumer movement corresponds with the closing of the
large mental hospital institutions around the mid 1980s to the early
1990s whereas in the United States and the United Kingdom,
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this process occurred over 20 to 30 years earlier. [18] Standard 9 of the
Mental Health Standards [19] urges the involvement of consumers in all
aspects of mental health planning, implementation and evaluation,
but it pertains only to services and does not include the planning,
funding and decision-making bodies in the mental health and
addictions sector in New Zealand.The literature discusses how much
consumer participation and involvement in the sector on much larger
scale is greatly needed [20] but there was very little that talked to
consumer leadership in the sector. Energy has been targeted towards
involving consumers in aspects of mental health service planning
and service delivery, but the absence of literature shows that in
New Zealand, no firm commitment towards an agenda for consumer
leadership has been planned in a well-thought-out manner.
2.1.4 Consumer leadership participation
In discussing how communities and certain members of society
are disempowered, Arnstein (1969) developed a model to
illustrate the ways in which certain population groups may
be disadvantaged. For Pacific consumers and consumers in
general the underlying issues are essentially the same;
nobodies in several arenas who are trying to become
Figure 2: Arnstein’s Ladder of Participation (1969)
8
7
6
5
4
3
2
1
Citizen Control
Delegated Power
Partnership
Placation
Consultation
Informing
Therapy
Manipulation
[18] ibid
[19] Standards New Zealand, 2001
[20] Mental Health Commission 2007, 2004, 2002 & 1998; Ministry of Health, 2005
Citizen power
Tokenism
Nonparticipation

Figure 3 Description of Arnstein’s Ladder of Participation
Rung No. Rung Name Description
8
7
6
5
4
3
2
1
Citizen Control
Delegated Power
Partnership
Placation
Consultation
Informing
Therapy
Manipulation
Citizen power
Tokenism
Nonparticipation
This is where the previously disempowered have
the entire ownership and responsibility for planning,
policy-making and/ or full managerial and
governance power.
The formerly disempowered have a clear majority
on decision-making bodies and are delegated powers
to make decisions.
Power is redistributed through a negotiation process
between the disempowered and power holders.
There is shared planning and decision-making
through joint committees for example.
Decision-makers select those whom they deem
worthy to sit on committees that make decisions.
In this the disempowered can advise or plan but allows
the power holders the exclusive right to judge
the feasibility and legitimacy of the advice offered.
This is a legitimate step in the right direction, but is
often a window dressing ritual for the power holders
to be seen to be sharing information with the
disempowered.
A crucial first step for the disempowered becoming
engaged in legitimate participation. On the other
hand there is only a one-way flow of information
with no channel to present feedback.
The aim is to cure or educate the disempowered
with very little or no thoughts around involving
them whatsoever. The detrimental effects of such
treatment are confidence-breaking and cause many
set backs in a consumer’s recovery [21]
somebodies with enough power to make the target institutions
responsive to their views, aspirations and needs. As demonstrated in
Figure 2, rungs 1-3 are measures of non-participation while rungs 4
& 5 denote tokenism. Rungs 6, 7 & 8 are full citizen power or in this
case full consumer control, ownership, independence and leadership.
There is also a need to be mindful of the gaps and imbalance in the
sector in terms of the mental health agenda being more represented
than addictions, of adult-centric services and consumer voices being
the most powerful at the expense of the youth and child voice being
overlooked, of Pacific services and consumers being at the bottom of
the heap compared to mainstream, and that consumers’ aspirations
are often overlooked because organisational needs are often more of
a priority and they have the decision-making power. [22]
[21] Mental Health Commission, May 2002
[22] Mental Health Commission, 2002, p.15
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Freire [23] also talked about the power-holders choosing selected
leaders from the disempowered, who are able to speak their
language, mimic their behaviours and actions. It is assumed that the
chosen leaders will do as the power-holders say because they are
so thankful for the opportunity to be chosen. This is identified as a
strategy to deflect accusations of power-holders possessing an unfair
advantage. The power-holders then isolate the selected leaders in a
further move to keep them powerless and working against the other
disempowered people. While Arnstein and Freire’s theories were
proposed in 1969 and 1970 respectively, the essence of their work
is still very relevant today, as evidenced in the stakeholder feedback
section of this report.
2.1.5 Defining recovery
The notion of recovery is a fundamental principle that underpins
the foundation of the mental health and addictions sector in
New Zealand. The literature espouses that the mental health
and addictions sector is re-oriented towards a recovery focus
to better serve consumers to become as autonomous as
possible and have long-term wellbeing. Recovery takes place
for consumers when “…we regain personal power and a valued
place in our communities…” [24]
Personal power leading to recovery for consumers has been further
defined [25] by the following:
• Experiencing hope and optimism
• Making sense of our experience
• Managing our mental health
• Knowing how to get the most out of services
• Advocating for our rights and inclusion
• Belonging to the culture and lifestyles we identify with
• Fulfilling our goals, roles and responsibilities
• Maintaining our personal relationships
Central to the idea of recovery is the belief that …”everyone with
experience of mental illness and/or addiction can live meaningful
lives and contribute positively to the communities in which they live
in.” [26]
2.1.6 Pacific consumers & families
It is a paradox that Pacific consumers recover more thoroughly
and more long-term when they have their family support, [27]
yet the biggest stigma and discrimination is found within the
families of Pacific people. [28] Malo (2000) asserts that this
hindrance arises because of the lack of understanding that
Pacific families have about mental health diagnoses and the
mental health and addictions system, yet no matter how much
[23] Freire, Paulo (1970). Pedagogy of the Oppressed
[24] Mental Health Commission, June 2004, p.15
[25] Northern DHB Support Agency, p.8
[26] Mental Health Commission, August 2007
[27] Annandale & Instone, 2004
[28] Peterson et al, 2004

Table 1: Pacific consumer-specific workforce
they discriminate Pacific consumers stay alongside their loved ones.
In most Pacific consumer gatherings in New Zealand, family members
are almost always invited to be key stakeholders (for example
the Pacific Northern Regions Consumer & Family Forum) [29] . This is
because Pacific consumers on the whole strongly believe that family
support and involvement is a crucial factor to their recovery. [30] This
practice of combining consumers and family members together in
every aspect is at odds with the consumer movement internationally
and within mainstream New Zealand where the focus on service user
development and progress often excludes family/ whanau members
because of past hurtful experiences. The involvement of families is a
key component in the holistic wellbeing of Pacific consumers. [31] (Ibid)
When a measure is based on the concept of health and recovery
prevalent to one culture, it may not measure aspects of health and
recovery that are important to people from a different culture. [32]
2.2 The service-user workforce
Although employing consumers within DHB and NGO mental health
services appears to be standard practice of late, the number of
consumers working in the mental health and addictions sector in
both generic and consumer-specific roles remains unclear. [33] Several
stock-take surveys of the sector workforce have been conducted, with
recent examples specifying consumer-specific roles such as consumer
advisors, consumer trainers, and peer support workers.
A recent survey of the NGO workforce by Platform (2007 reported
that of the 1833 respondents, 18 listed their roles as consumer
advisors and were grouped with other management-type roles; 52
identified as peer support workers two of which were Pacific. Another
survey, conducted by the Werry Centre, of the child and adolescent
mental health workforce reported a total of 5.35 FTEs for specific
mental health consumer roles, however none identified as Pacific. [34]
Role MHC (2001) Platform (2007)
Consumer consultants 4
-
Peer support workers (NGO only) - 2
TOTAL 4 2
[29] This forum, which meets monthly, is a Waitemata DHB initiative and provides a platform for Pacific consumers and their families in the Auckland region to gather and
share their thoughts, ideas etc
[30] Malo, 2000
[31] ibid
[32] Faleafa and Lui (2005)
[33] Hansen, 2003
[34] Werry Centre, July 2007
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It is difficult to make comparisons and draw conclusions from the
findings of these different surveys as the data collection methods
vary and often serve a specific need. For example the Werry Centre
focused on the CAMHS workforce while Platform investigated the
NGO workforce of its member organisations.
2.2.1 The service-user workforce strategy [35]
Recent Ministry of Health reports emphasise the importance
of supporting the development of the service-user workforce
and the fostering of a culture amongst providers that promotes
service user participation and leadership. [36] To support this
initiative, the Mental Health Commission released the Service
User Workforce Development Strategy for the mental health
sector 2005-2010 report. The strategy outlined key areas
and plans for developing the service- user/ consumer workforce
describing the consumer workforce in mental health (and
addiction) as “anyone who is currently or has previously
accessed mental health (and addiction) services” (sync). The
consumer workforce, according to the strategy, is comprised of
the following:
• Consumer specific roles: roles that are created specifically
for consumers, such as consumer advisors, advocates,
representatives, peer support workers etc
• Generic roles: roles that can be filled by suitably
qualifiedindividuals, including those with lived mental
health and addiction experience such as support workers,
psychologists, managers and others
The strategy highlights the following key points as the rationale for
service-user workforce development.
Philosophy
• Recovery: the notion of recovery provides the foundation of
how services should be delivered. Often this approach is
service-user-led and centered because of their unique
expertise derived from their experience
• Human rights: service users are afforded the same
fundamental rights as others and this needs to be reflected
in the way services are run so that they enable service-user
participation and leadership. Workforce development is one
approach to developing service-user participation and
leadership, as well as contributing to their rights as citizens
to work in the open labour market
• Consumerism: based on its origins in the commercial sector,
consumerism implies that the interests of the consumer
must be paramount to the people and systems that provide
them with goods and services. And who better to provide
such services than people who know and understand what
service users are going through
[35] Mental Health Commission, 2005
[36] Ministry of Health, December 2006, p11; June 2005

[37] MHC, 1998; MoH, 2003 etc
[38] MoH, 1996; MHC & MoH, 1996; Health Funding Authority,
2000; MoH, 2002; MoH, 2005; MoH, 2006
[39] CMDHB, 2008
• Pluralism: highlights the increasingly diverse nature of
New Zealand society and the need to reflect this in the
workforce, including the service-user workforce
Pragmatism
• Service users have unique areas of effectiveness and offer
skills such as empathy, a lived understanding of mental
illness, recovery and using services in both consumer-specific
and generic roles
• Service users are an untapped workforce and their potential
to the sector is yet to be realized despite many current users
of mental health services being unemployed with some
expressing a desire to contribute
• Service users can help fill workforce shortages. They have
the lived experience to make positive contributions to the
workforce needs of the sector
Policy
• Generic policy: a number of key government documents
clearly stipulate the need to support and develop the
consumer workforce in the sector [37] .
• National workforce policy: most, if not all of the national
workforce policy documents to date specify the need to
develop the service user workforce [38] yet virtually no or
little action, has come out of these documents
• Regional workforce policy: at regional level, many workforce
plans and policies have stipulated the need for developing
they discriminate Pacific consumers and establishing a
competent workforce in order to respond effectively to the
needs of consumers. In most cases however, the plans do not
explicitly highlight the need for developing and growing the
service-user workforce especially at policy level. Often it is
assumed that any workforce development strategy includes
consumers, however the lack of consumer presence in
strategic positions clearly shows that this is not the case.
2.2.2 Counties Manukau District Health Board Pacific Mental
Health and Addictions Implementation Plan
CMDHB recently released its Pacific Mental Health and
Addictions Implementation Plan 2008 – 2010 [39] .
The goals of the plan include:
• Well Pacific families and communities;
• High quality mental health and addictions primary health
care services
• Responsive mental health and addictions services and
their families
• Pacific children and young people in Counties Manukau
who are affected by mental health, alcohol, drugs and
gambling problems access quality and appropriate services
• Pacific people and their families are able to access
effective and appropriate addictions services
21

22
• Older Pacific people and their families in Counties Manukau are
able to access effective and appropriate mental health and
addictions services
• Competent mental health and addictions workforce
• Mental health and addictions services are based on the philosophy
of Quality Improvements
What differentiates this plan from others is that one of its key
objectives clearly articulates the need to support the development
of the consumer workforce in terms of their professional skills,
leadership skills and participation in mental health and addictions
service planning, design, delivery and evaluation. It also promotes
the need to develop community leadership in delivery and evaluation
processes.
2.2.3 Strengthening our Foundations: Service User Roles in the
Mental Health Workforce [40]
Commissioned by the Mental Health Foundation, Hansen (2003)
completed a project exploring some of the issues facing service users
in the mental health workforce. In summary, the report highlighted
the following key workforce issues for service users including:
• Stigma and discrimination including inequity, penalisation and
labelling
• Lack of advocacy for service users employed within mental health
services
• Experience of mental illness a barrier for career development
• Lack of support resources and reasonable accommodation for
service user mental health workers
• The need for more workers in clinical, management and other
roles with experience of mental illness to influence change
The report made the following key recommendations:
• The development of guidelines for employers, both DHB & NGO
with regard to service-user roles
• The need for a training framework and training needs assessment
tool for service users
• The building of a culture of acceptance among providers through
education packages for employers, the establishment of policy
guidelines and setting up of a service-user union
• The reduction of stigma and discrimination through recovery and
strengths-based training and workshops for recognizing and
reducing discriminatory behaviour and attitudes
• Implementing a programme of affirmative action for service users
[40] Hansen, 2003

2.2.4 Competencies for consumer advisors in mental
health services [41]
In 2005, the Mental Health Workforce Development Programme in
conjunction with the Health Research Council of New Zealand (HRC)
developed a set of competencies for consumer advisors working
in mental health services. The key findings from this report that
are applicable to the development of a leadership framework are
summarized below. [42]
Figure 4: Consumer advisor role competencies [43]
Recovery principles
& approaches
Standards
Accountabilities
Treaty of Waitangi
Culture &
diversity
Knowledge of the
role/position
Discrimination
Passion
Open-minded
Leadership
Evaluation
Ethics
Management Professionalism
Organisational
development
Presentation skills Facilitation
Project Management
Knowledge Admin & IT Skills
Ethics
Legistration
Health sector
Consumer movement
[41] Health Research Council, 2005
[42] The full report is available from www.hrc.govt.nz
[43] Adapted from HRC, 2005
Collegial
Empathetic
History & development
of the position
Policy
Has attained degree
of wellness
Personal &
professional
integrity
Models of
Care
Services &
systems
Promotion &
prevention
Self-awareness
Belief in
Recovery
Personal Attributes
Honest
Sense of
humor
Resilient
Networking
Assertive
Motivated
Mental illness &
service user
experience
Organisational
vision & strategies
Systems advocacy
Written & verbal
communication
Driver’s licence
Interviewing
Self management
Conflict resolution
Interpersonal skills
Continuous quality
improvement
23

24
The HRC report describes competencies as “a combination of
attributes, skills and knowledge that contribute to a person’s ability
to perform a job to an appropriate standard.” The competencies are
categorized in three distinct areas.
• Personal attributes refers to a range of personal experiences,
values and belief systems a person brings to the role
• Knowledge is the information that the person requires to
undertake the role
• Skills describe the abilities a person requires to undertake the role
Each competency category has four main application levels
including core (essential for the position); recommended
(additional core competencies beneficial to the role); practiced
(preferable for the position); and desirable (nice to have but
not essential to the position). Levels of attainment in each area
of competency are rated numerically from 1 (not attained), 2-6
(partially attained) and 7 (fully attained).
2.2.5 Peer support
The Peer Support programme is a service-user-specific workforce
initiative which formally recognises the merits of service-user mental
health and/or addiction experience and its contribution to the sector.
It can be defined as “a relationship grounded in shared experiences.
It is mutual, reciprocal, and equal and can promote relationships that
foster responsibility and critical self-awareness.” [44]
The programme has gained ground in New Zealand in recent years
and is aimed at training service users to become specialist support
workers in mental health and addiction services. Once trained, peer
support workers are employed to provide support for other service
users and with their own experience of using mental health and
addiction services they are able to offer a unique and understanding
perspective in the way they work. The roles and responsibilities of a
peer support worker are varied, but generally they assist others with
their recovery journey and goal setting. As such, a certain level of skill
and knowledge is required to fulfill the role of a peer support worker.
These are described in full on the Skills Matter website
www.skillsmatter.co.nz
Peer support training is provided by a range of providers in
New Zealand and the content, quality and duration varies depending
on the provider.
The two main modes of training delivery include in-house training
where providers employ and train peer support workers within
their organisation, and generic training programmes where
people are taught before they become employed. For Pacific peer
support workers and others who work with Pacific service users an
understanding of Pacific cultures, values, protocols and customs is
crucial to the role. [45]
[44] Orwin, 2008
[45] Ibid

2.2.6 Wellness Recovery Action Plan
The Wellness Recovery Action Plan (WRAP) is described as a “peoplecentered,
self-management system designed by consumers.” [46]
WRAP is a tool widely used in the development and care of service
users on their journey of recovery. According to Copeland the five key
recovery concepts which underpins the WRAP programme include:
• Hope: people who experience mental health difficulties get well,
stay well and go on to meet their life dreams and goals
• Personal responsibility: it is up to consumers, with the assistance
of others, to take action and do what needs to be done to keep
them well
• Education: learning all you can about what you are experiencing so
you can make good decisions about all aspects of your life
• Self advocacy: effectively reaching out to others so that you can
get what it is that you need, want and deserve to support your
wellness and recovery
• Support: while working toward your wellness is up to you,
receiving support from others, and giving support to others will
help you feel better and enhance the quality of your life [47]
In New Zealand, WRAP training is provided by a range of providers
in a variety of training settings. It is unclear whether these training
workshops including Peer Support training include a module on
Pacific models of care and cultural values.
2.2.7 Let’s get real: real skills
Let’s get real: real skills for people working in mental health
and addiction is a key document that is complementary to the
objectives of this project. The real skills framework describes the
essentialknowledge, skills and attitudes required to deliver effective
mental health and addiction treatment services.
[46] Copeland & Mead 2004, cited in Tse et al, 2008
[47] www.mentalhealthrecovery.com
25

26
The aims of Let’s get real include:
• Strengthening shared understandings between key stakeholder
groups which includes services users
• Affirming best practice
• Complementing the Health Practitioners Competence Assurance
Act 2003
• Improving transferability
• Enhancing effective workforce development
• Increasing accountability
The Let’s get real framework is underpinned by the following values:
respect, human rights, service, recovery, communities, relationships
and it stipulates that people working in mental health and addiction
treatment services need to be compassionate and caring, genuine,
honest, non-judgmental, open-minded, optimistic, patient,
professional, resilient, supportive, and understanding.
The seven key areas or Real Skills of Let’s get real broadly address the
following:
• Working with service users
• Working with M ori
• Working with families/whanau
• Working with communities
• Challenging stigma and discrimination
• Law, policy and practice
• Professional and personal development
2.3 Defining leadership
Leadership is a complex concept to define, however in its most
basic form leadership can be described as the ability to lead or the
act or instance of leading. [48] The research on Pacific leadership is
very limited but one Pacific construct of leadership is described by
the Samoan proverb “o le ala i le pule o le tautua”, which loosely
translates to “the way to leadership or power is to serve.” [49] In other
words, one does not lead by being controlling or serving one’s own
self-interest, but rather by placing and acting upon the needs of
others, their family or community i.e. to lead is to be of service to
others.
In the context of mental health, Happell & Roper (2006) argue
“consumer leaders can be those who strive towards the achievement
of a mental health service that provides clear opportunities for
consumers to participate in mental health service delivery on an
individual and (if desired) a systemic level. Consumer leaders can
hold roles within mental health services, academic institutions and
government departments”.
[48] www.m-w.com (Merriam Webster Online Dictionary)
[49] Siauane, 2004,p33

Table 2: Levels of Leadership Participation 51
Leadership
Type/Level
IV Charismatic-Transformational
III Transformational
II Relational
I Transactional
[50] Source: Strategos Inc, 2003. Website www.strategosinc.com
[51] Lean manufacturing leadership, 2003, p4
2.3.1 Types of leadership
The literature broadly describes four key types of leaders, which are
summarized in Table 3 below. For situations or issues that are simple,
clear and technical in nature the lower level styles of leadership
(eg. transactional) appear to work best; however for more complex,
high-level situations, charismatic or transformational leadership styles
are more effective. [50]
Activities & Competences Personal characteristics
• All of Level III +…
• Personal charisma
• All of Level II +…
• Frames holistic issues
• Sets new goals & direction
• Creates meaning
• Manages creative conflict
• Promotes organizational learning
• Creates a context for dialogue
• Manages paradigms
• Creates commitment through
shared values
• Assertive
• Seizes opportunities
• Tolerates risk
• Uses systems thinking
• Creates commitment through
participation
• Motivates intrinsically
• Promotes teamwork
• Manages politics
• Works within existing system
• articipative and consultative
• Accepts organizational goals
• Uses extrinsic motivators
• Works within existing systems
• Takes action
• All of Level III +…
• Self-confident
• Knows himself/herself
• Eloquent
• Free of internal conflict
• Expressive emotionally
• Assertive
• Seizes opportunities
• Tolerates risk
• Uses systems thinking
• participative and
consultative
• Directive
• Dominating
• Action-oriented
27

28
2.3.2 Levels of leadership participation
Leadership participation refers to the decision-making process
employed by various leaders. For the most part the literature
on leadership recognizes that there are four levels of leadership
participation, which includes the following:
Autocratic decisions: decision is made alone without asking for
opinions or suggestions of people. Followers or team members
have no direct influence on the decision. Often this style may cause
alienation among followers if used often. This style of leadership is
considered the most effective in crisis or emergency situations
Consultation: followers are asked their ideas and opinions, then the
decision is made alone after seriously considering their concerns and
suggestions
Joint decision: the leader meets with others to discuss the problem
and make decisions together. The leader has no more influence over
the decision than any other participant
Delegation: in this instance leaders give an individual or group
authority and responsibility for making decisions. The leader usually
specifies limits in which the decisions must fall. [52]
2.3.3 Key attributes of effective leaders
Strong and effective leadership is the lynchpin of any system.
Leaders are those who are able to influence others to create
change, set high standards and take ownership of the goals and
aspirations of the organization. [53] Essentially the qualities of an
effective leader, according to De Vita & Fleming, include the ability to
create an environment that allows team members to perform well
develop strategies to engage, mobilize and inspire team members;
communicate their ideas clearly; advocate strongly; think strategically
and maintain organizational momentum; and utilize staff and their
skills effectively and where necessary draw on the skills of outsiders.
In addition, De Vita and Fleming strongly support the notion of
growing leadership capacity through enhancing existing leadership
and developing new leadership.
They also emphasise the importance of preparing and grooming
younger people to take on leadership roles as crucial to sustaining
the sector’s ability to meet the changing needs of the mental health
and addictions landscape.
[52] weLEAD, 2001
[53] De Vita & Fleming (2001)

Figure 5: Proposed 4C model adapted
from Mariner’s 3C model
Consumer
Corporate Clinical
Cultural
2.3.4 Notions of Pacific health leadership
In the absence of specific Pacific health or mental health leadership
research Mariner’s (2008) Masters thesis is utilized to elicit some
Pacific values and belief systems that may be pertinent to consumer
leadership in the health and mental health sectors. While Mariner’s
research describes the necessary attributes required to manage a
Pacific health service effectively, there are elements in his research
that may be relevant to the broad spectrum of Pacific mental health
and addictions consumer leadership. The majority of participants
in Mariner’s study were established or emerging managers/
leaders in the health sector of Pacific descent, with most holding
an undergraduate or higher qualification. In his research, Mariner
describes four domains of effective managerial attributes including:
• Personality: where desirable attributes for managing a Pacific
health service include being nurturing, extroverted, high spirited,
entrepreneurial, assertive, authoritative and humble
• Knowledge and learning: participants in Mariner’s research agreed
that Pacific health managers should have an understanding
of general knowledge and history of the organization as well as
familiarity with socio-behavioural theory and managerial
theoretical frameworks
• Skills: Pacific health managers should have an understanding of
classical management theory with an emphasis on administrative
skills, human relations theory in relation to behavioural
management and political management skills
• Beliefs and values: with emphasis on relationships whereby
people were seen as basically good
The participants in Mariner’s paper highlighted the following
additional attributes as critical for effective management of Pacific
health services: respect, integrity and honesty, cultural awareness,
self-awareness, knowledge of Pacific languages and family and
relationships.
Mariner proposes the 3C model
as a framework for Pacific health
management.
The three Cs relate to the principal
roles of cultural, clinical and
corporate expertise, which form an
overlapping tripartite relationship
each responding to specific areas of
organizational management. Each
component functions as a collective
unit that is dependent on the other.
A key Pacific consumer advisor and
leader interviewed for this project
noted that a fourth C representing
the consumer would further enhance
Mariner’s model, acknowledging
29

30
the fact that consumers are also an integral component in service
design, delivery and management.
2.4 Leadership development frameworks
and initiatives
The increasing recognition of the significance of leadership in the
mental health and addictions sector is testament to its importance
as a key component of workforce development strategy and service
improvement. [54] This section summarises local and international
examples of leadership development frameworks and programmes
with relevance to Pacific consumer leadership development.
2.4.1 Midland Leadership Framework
This local leadership framework is developed to meet the needs of
leaders and managers from the Waikato, Tairawhiti, Bay of Plenty,
Taranaki and Lakes regions, and based on the DHBNZ Leadership
Competency Framework.
The aim of the Framework is:
• To create a pathway that advances the skills and knowledge in
leadership and management for the DHB Midland region
• To ensure that all Midland leaders and managers have learning
opportunities that challenge them to extend their present
level of practice
• To assist Midland to retain its leaders by offering high quality
in-house
development
opportunities and
career development.
Figure 6: Midlands Leadership Framework
New or emerging
leaders/managers
should ideally begin
at the lower level
and work their way
upwards but in the
order that suits their
individual needs,
desires or role.
Bordering the three
sides are concepts
inherent throughout
all the learnings and
levels, these being
the Competencies,
Personal development
needs and Mentoring/
Coaching or Buddying.
Services
Specific
Orientation
Health
Leaders
Advanced
Programme
Local
DHB ‘Way’
leaders personal development needs
Midland
Network
LAMP
Leadership
Snapshots
[54] CMDHB, 2008, p23; Minister of Health, 2006, p39 & 40; Ministry of Health, December 2005; p16; June 2005, p12
Mentoring Coaching Buddy
PG
Certificate
Deploma in
Health Sciences
Personal
Development
Plan
Health
Leaders
Foundation
Programme
DHBNZ Leadership and Management Competences

2.4.2 The DHBNZ Leadership Competency Framework
The DHBNZ Leadership Competencies Framework is outlined below [55]
Table 3: DHBNZ Leadership Competencies
Leadership Competencies Key Elements
Demonstrates Personal Insight
Demonstrates a mature confidence of oneself as a leader
and exhibits self management and adaptability to address
issues on their merit; demonstrates an awareness of the
environment and shows resilience in the face of conflict
and ambiguity
Models Organisational Values
Establishes principles regarding the way people should be
treated; leads by example; earns respect and behaves in a
consistent and ethical manner; aligned with organisational
values
Inspires Commitment
Inspires others to commit at both a rational and emotional
level; applies an understanding of people to motivate and
influence them
Gets Things Done
Demonstrates the achievement of high performance goals
and standards; clarifies expectations; takes responsibility
for the delivery of quality results and focuses on resources
to achieve organisational goals
Finds Better Ways
Optimises key processes by finding ways to get things
done faster and more efficiently and by removing barriers
to progress
Creates a Shared Vision
Creates a vision of the future, creating an ideal image of
what might be; passionately enlists others to see future
possibilities and achieve visions
Values Diversity
Demonstrates awareness, understanding and appreciation
of diversity and makes diversity an asset
Makes Decisions
Makes effective decisions within the context of healthcare
strategies and operations, after seeking and reviewing
available data
Develops Self and Others
Builds capability through demonstrating commitment to
the development of people and creates an environment
where continuous learning and development are
encourage
[55] Source: www.midlandleadership.co.nz
• Self awareness
• Mature confidence
• Resilience
• Adaptability
• Leads by example
• Ethical
• Earns respect
• Motivates others
• Builds relationships
• Communicates with influence
• Provides direction
• Sets demanding goals
• Delivers on commitments
• Tackles performance issues
• Recognises contributions and
celebrates success
• Implements effective systems and processes
• Demonstrates innovation
• Removes barriers
• Thinks strategically
• Envision the future
• Enlist others to the vision
• Recognises individual differences
• Demonstrates interpersonal and cultural
sensitivity
• Upholds the Treaty of Waitangi
• Demonstrates insights into key issues
• Understands the nature of the health sector
• Analyses and resolves problems
• Focuses on effective action
• Coaches and develops others
• Focuses on personal learning and growth
• Stimulates learning and manages knowledge
31

32
2.4.3 The Excelerator Leadership Development Framework [56]
Excelerator is a national leadership development and research
institute based within the University of Auckland. The institute
delivers a suite of leadership programmes including:
• The Hillary Leadership Programme aimed at developing and
enhancing the leadership skills of senior executives
• The Future Leaders Programme is a leadership development
programme designed specifically to challenge young people and
the way they think about themselves and relate to others in their
sphere of work and socialization
• The Leadership Community Programme is designed for those who
work with particular communities to further enhance their
leadership skills and capabilities
The Excelerator Leadership Development Framework is designed for
those with tertiary qualifications or equivalent life experience. As
illustrated below the Framework encompasses three dynamics that
are integral to developing leadership.
Figure 7: Excelerator leadership Development Framework
Relational Dynamic Self Dynamic
Contextual Dynamic
Evolve Leadership
identity
Extend understanding
of Leadership
Build a
learning practice
Create an environment
for trust and creativity
[56] Source: www.midlandleadership.co.nz
Focus on Leadership
conversations
COMMUNICATION
Develop multiple
perspectives
RESPONSIBILITY
Strengthen the
collection interactions
CREATIVITY
Seeing patterns
& possibilities
Action & Impact
Interdepentence
Enact the collective capacity
Collectively holding complexity

2.4.4 NHS Leadership Qualities Framework (UK) [57]
In 2001 the National Health Services (NHS) in the UK, via its
Leadership Centre, developed a Leadership Qualities Framework
(LQF) following extensive consultation with key stakeholders over
a two-year period. This Framework was produced as a resource for
supporting the development of directors and senior managers within
the health sector in the UK.
The Framework contains fifteen qualities encompassing a range of
personal, cognitive, and social qualities. These qualities are couched
within three key domains including Personal Qualities, Setting
Direction and Delivering the Service, which are illustrated in the
figure below.
Figure 8: NHS Leadership Qualities Framework
Seizing
the future
Intellectual
flexibility
Leading change
through people
[57] Source: www.nhs.gov.uk
[58] Centre for Excellence in Leadership, Nov 2004
Holding to
account
Broad
Scanning
Setting
Direction
Personal Qualities
Self belief
Self awareness
Self management
Drive for improvement
Personal integrity
Delivering the
service
Political
astuteness
Empowering
others
Drive for results
Collaborative
working
Effective
and strategic
influencing
A full explanation of this Framework is described in Appendix 4.
The NHS LQF is targeted primarily at senior executives and/or
management who work within the health sector in the UK. It is
designed to provide a standard practice of leadership development
within the sector.
2.4.5 Centre for Excellence in Leadership (UK) [58]
The Centre for Excellence is a national UK government initiative
formed in 2003 as the epicenter for leadership and skills
development across the public sector with particular attention to the
education and skills division. Launched in 2004, the Leadership
33

34
Framework is drawn from pertinent research and consultation with
key stakeholders within the public and private sectors. It profiles key
leadership characteristics and effective behaviours and qualities that
enhance leadership. The Framework focuses on the following key
areas illustrated in the diagram below:
• Achievement
• Impact through mobilisation
• Sustaining momentum
• Passion for excellence
Figure 9: Centre for Excellence in Leadership (UK) Tramework
shaping
the future
Buciness
acumen
Action
orientation
Focus to achive
Cultural
seneitivity
Organisational
expertise
Leadership
Framework
Mobilise to impart Sustain momentum Passion for exce
Influential
relationships
Performance
accountability
Distributed
leadership
Change
management
Building organisational
capability
Growing future talent
Driving for
results
Common purpose
Drive and direction
Learning orientation
Self awareness
and growth
llence

Figure 10: Leadership Qualities Framework Quadrant
D. Passion
for Excellence
C. Sustain momentum
The diamond quadrant below describes four levels of attainment for
each quality:
4 Guide: exceptional performer exhibiting core characteristics
3 Perform: strong performer in many but not all key actions;
emerging talent - enhanced performance capabilities
2 Assist: performs well in the core areas; needs some development
in one or more areas or complex key actions
1 Learn: performs with leadership skill in basic key actions; has
significant development needs in several areas
2.4.6 Leadership training programmes
1
A. Focus to achieve
2 3 4
B. Mobilise to impact
There are several consumer initiatives occurring at provider (micro)
level with varying degrees of success and documenting these is
beyond the scope of this project. However, feedback from some
service providers indicates that most of these programmes, which
are often ad hoc, are vocational, in-house based programmes aimed
at developing the work and inter- personal skills of service users, a
key component of leadership development. One provider had plans
to trial a consumer-led business entity as a means of promoting
consumer development and independence and aiding in their
recovery.
The following table contains a summary of Pacific-specific and generic
leadership training programmes available in the sector, and brief
details on consumer advisor training that could act as a stepping
stone to more advanced leadership training courses.
35

36
Table 4: Summary of selected leadership training programmes
Focus areas Qualifications Information
source
Target audience/
Entry requiements
Organisation/
Provider
Programme name &
brief description
www.leva.govt.nz
Certificate
The programme focuses on personal development in preparation for
future career growth including:
• Developing critical skills for leadership
• Success improving productivity and effectiveness
• Discovering skills for effectively managing important projects
• Developing strategies for dealing with difficult people and conflict
• Learning how to develop and coach others
• Improving strategic thinking and planning skills
• Pacific emerging leaders in
the mental health and
addiction sector
• Ideally applicants will have
some management or
team leadership experience
especially within the sector
• Although not explicitly
stated this programme is
also open to Pacific
consumers
Le Va (Te Pou) in
partnership with
Blueprint
Le Tautua - Pacific Emerging Leaders
Management Programme
A Pacific-specific mental health and
addiction leadership course for emerging
leaders
www.moh.govt.nz
Post graduate
certificate (can
be cross-credited
qualifications)
The primary aim of this programme is to produce a distinctive
leadership development experience which recognises different
learning and leadership styles
• Established Pacific leaders
working in the health sector
including mental health and
addictions
• University qualification or
extensive experience in
management, preferably in
the health sector
Ministry of Health
in partnership with
Canterbury University
Pacific Health Leadership Programme
This programme was developed
by a consortium of agencies and is
implemented by the University of
Canterbury. The consortium includes:
• Ministry of Health
• The Leadership
Development Centre
• District Health Boards
New Zealand
• Niu Vision Group Ltd
• Senior Pacific health and
community leaders
www.blueprint.co.nz
Certificate
with option for
gaining formal
qualifications
Similar to above but at more advanced levels.
Senior Executives and
Managers working in mental
health and addictions (Tertiary
level qualification and/or
equivalent experience)
Blueprint in partnership
with Waikato
University
Advanced Executive and Management
Leadership Programme (AELMP)
An advanced course of Blueprints ELMP
programme

Continued
Focus areas Qualifications Information
source
Target audience/
Entry requiements
Organisation/
Provider
Programme name &
brief description
www.blueprint.co.nz
Certificate (with the
option of gaining
further formal
qualifications)
The key areas covered include the following:
• History of the mental health and addictions sector in NZ
• Key policy and legislation
• Future strategy
• Personal awareness
• Creativity and innovation
• Work-lifestyle integration
• Performance assessment
• Human resource management
• Strategic service planning
• Media and communication
• Managing in Diversity
• Community capacity
• Working across the system
Senior Executives and
Managers working in mental
health and addictions
(Tertiary level qualification
and/or equivalent experience)
Blueprint in partnership
with Waikato
University
Executive Leadership and Management
Programme (ELMP)
Aimed at senior managers and executives,
this programme was developed specifically
to meet the needs of leaders in the
mental health and addictions sector
www.blueprint.co.nz
Certificate
The key focus areas include:
• Discussion on the Consumer Advisor role within the mental
health and addictions sector
• Developing and cultivating; participants key skill areas with
regard to carrying out the Consumer Advisor role at an
advanced level
• Building on and augmenting the participants’ current skills and
knowledge, utilising this to enhance professional development
• Inspiring, challenging and educating through engagement
and collaboration with talented and experienced facilitation and
training
• Promoting networking opportunities, connections and consumer
community awareness
• Advancing the value and significant contribution of the
Consumer Advisor role within the mental health and addictions
sector
Consumers who work as
advisors for 20hrs or more per
week.
Blueprint
Consumer Advisor Training
The training programme covers the following four core areas:
1. Personal skills
2. Communication skills
3. Professionals skills
4. Management skills
37

38
Other Leadership Programmes
Focus areas Qualifications Information
source
Target audience/
Entry requiements
Organisation/
Provider
Programme name &
brief description
www.dhbnz.org.nz
Certificate
This programme is delivered by
various LAMP providers and contains the following broad goals. Develop
the leadership and management skills of individual participants.
• Deliver measurable return on investment to the sector through
projects and improved skills
• Provide an opportunity for personal development for individuals
• Build national and international relationships and networks to
advance the health and well-being of New Zealanders
Managers, team
leaders, health
professionals,
clinicians etc.
DHBNZ (course delivered
by LAMP providers)
Advanced experience and/or
tertiary qualification
Leadership and Management Programme
(LAMP)
There are four programmes within the
LAMP:
• Top Management Programme –
aimed at senior managers including
those whose next career step is to
Chief Executive Level.
• Management Action Programme –
designed for existing District Health
Board, Ministry of Health and other
health sector managers who wish to
enhance and consolidate their
performance in their current role.
• Health systems and management for
clinicians – is a 6-month programme
for clinical leaders in leadership roles
that may include a management
component.
• Primary health leadership and
management – is a 5 month
programme designed for people with
an advisory or leadership role, board
members or those with a good deal of
experience who are looking to
invigorate their leadership skills and
build networks
www.iimhl.com
na
Leadership development and innovative managerial approaches
through international exchange programmes.
Managers, CEO’s
leaders etc in the mental
health sector. Some relevant
leadership experience and/or
tertiary level qualification.
na
International Mental Health Leadership
(IMHL) Exchange Programme
IIMHL is a “virtual” agency that works to
improve mental health services by supporting
innovative leadership
processes

2.4.7 Leadership frameworks and programmes: some
key points:
• The majority if not all, of the leadership frameworks presented
above focus on individual leadership development through the
attainment of certain sets of skills, values and experiences
• There were no Pacific consumer leadership frameworks nor were
there any leadership programmes specifically for Pacific consumers
• Most of the leadership training programmes and opportunities
are targeted at emerging or well-established managers, CEO’s,
team leaders with tertiary-level qualification and/or equivalent
work experience
• Leadership is recognized as a key component of workforce
development
2.4.8 Summary of literature review
The literature shows there is widespread acknowledgment of the
important role consumers play in service planning and delivery, and
their contribution to the mental health and addictions workforce. A
key component of workforce development is leadership, and growing
and strengthening leaders within this cohort is essential. However
while some progress in sector leadership and consumer development
has occurred, a scan of the mental health and addiction landscape
reveals that much work remains in advancing consumer leadership
and the consumer workforce as a whole. [59] This is particularly evident
among Pacific consumers where very few are employed in the sector
and even fewer occupy positions of influence or senior management
roles.
The lack of genuine sector and provider commitment, and stigma,
were identified as significant barriers for realizing consumer
leadership potential. Few Pacific consumers have advanced toward
leadership positions and the development of a specific framework
for Pacific leadership development was highlighted as a key factor
in addressing this predicament. While a number of leadership
programmes and workforce initiatives, both Pacific and mainstream,
have existed for some time, it remains inconclusive after this
literature review, as to why Pacific consumer participation in such
programmes is a rarity.
Leadership is a complex, multi-faceted concept with numerous
definitions. The literature search yielded numerous examples of
leadership frameworks both locally and internationally. In addition,
a range of leadership training programmes and opportunities exist
with most targeting management personnel. A common thread
throughout these different leadership models appears to focus on
individual attainment of certain characteristics and/or values. Some
argue that these individualistic approaches may be premature and
that leadership is really a whole-systems concept rather than just
individual pursuit. Finally the literature acknowledges that leadership
development takes time and requires adequate and appropriate
resources.
[59] Doughton & Tse, 2005
39

40
3. Key informant
interviews and focus
group discussions
This section summarises the information collected from interviews
and focus group discussions with key stakeholders including Pacific
consumers and families, Pacific mental health and/or addiction
service providers, funders and others. [60] The key areas explored
during the consultation process addressed the following topics:
• A definition of Pacific consumer leadership
• Pacific consumer participation in the mental health and addictions
sector particularly at senior level
• The benefits of Pacific consumer leadership to the sector
• Existing Pacific consumer leadership development initiatives
• Gaps in Pacific consumer leadership
• Key success factors in a leadership development framework for
Pacific consumers
3.1 Defining Pacific Leadership
To define or describe Pacific consumer leadership the views of
consumers, family members, sector experts, clinicians, matua and
cultural advisors, community and church leaders, youth and many
others were sought.
It became apparent during the stakeholder consultation phase
that a single definition of Pacific consumer leadership was virtually
impossible. However unlike traditional definitions of leadership,
which often refer to individual leadership, Pacific consumer
leadership, according to the majority of participants is more than
just the individual. A Pacific consumer leader may be one person or
individual but he or she represents their aiga, the community and
their ancestors - that is the essence of Pacific consumer leadership.
When asked to describe Pacific consumer leadership or leader, the
majority of consumers referred to the few known Pacific consumers
in positions of influence in the current mental health and addictions
environment who manage somewhat to navigate
the realms of mainstream individualism versus
Pacific pluralism. A Pacific consumer leader needs
the right balance of
cultural, technical and lived
experience components. It
is a delicate balance that at
times can be challenging.
Culteral
context
[60] Informant and focus group information & questionnaire is described in Appendix 3
Lived
experience
Technical
context
Figure 11: Cultural and
technical balance with
lived experience

Based on the findings from the document review and stakeholder
consultations we attempt to define Pacific consumer leadership as
using skills and experience to act and/or advocate passionately on
behalf of Pacific consumers, tangata whaiora, service users and their
families to realize their potential by ensuring that their needs are
being met through influencing and optimizing service delivery and
systems processes in the mental health and addictions sector and in
other areas of society.
A breakdown of how this definition was derived is described below.
• Using skills and experience: an effective leader requires a certain
skill-level and relevant cultural, technical and lived mental health
experience
• To act: Pacific consumer leadership is action-oriented i.e. enough
with the talk get on the work! In other words a Pacific consumer
leader must walk the talk
• Advocate passionately: a leader is a conduit for other consumers,
and being a leader in this field requires a go-getter attitude,
resilience, optimism and courage, qualities captured in the word
passion
• On behalf of Pacific consumers and their families: alludes to the
notion of service to community, the consumers and their families
– ‘ole ala ole pule ole tautua’. This phrase also signifies the
leader’s linkages with their own families and communities who
stand behind him or her, that they are not alone in their journey of
leadership
• To realize their potential and ensuring that their needs are met:
this part of the definition relates to meaningful or purpose-driven
service. It is good to be of service to others but for what purpose
and why? This means that when working with consumers and
their families to achieve their goals there needs to be planning
and purpose to ensure that their needs are being met. And how do
we do this?
• By influencing and optimizing service delivery and systems
processes:- it is crucial that the definition acknowledges the critical
role that service providers, policy and government plays in mental
health and addictions, and a visionary Pacific consumer leader will
work with providers and contribute to policy that maximizes the
use of available resources in order to achieve service excellence.
During that process a leader is learning and growing
• Other areas of society: refers to the hope that Pacific consumers
can be leaders in any field and occupation, not just in mental
health
3.1.1 Pacific youth consumer perspective
The Pacific youth consumers who participated in this project describe
Pacific consumer leadership or leader as someone who has direction
or goals, sure about himself or herself, is able to listen to what others
have to say as well as being knowledgeable and capable of speaking
on behalf of other young people. They agreed that a competent
Pacific youth consumer leader would be someone who has common
sense, is independent yet able to relate well with others and have
41

42
great communication skills in various settings. Most agreed that while
educational qualifications are important having lived mental health
and addiction experience was just as important, if not more so. The
youth consumers also felt that while the ability to speak a Pacific
language or have adequate cultural knowledge may be advantageous
this was perhaps more relevant to their parents or older relatives.
Being street savvy and having the ability to relate to young people,
especially other youth consumers was crucial.
3.1.2 Pacific consumer perspective
While mainstream literature often depicts leadership as relating to
a set of personal characteristics an individual must attain in order to
lead an organization [61] , this viewpoint was generally acknowledged
as premature by the overwhelming majority of Pacific consumers
who participated in this project. Although personal characteristics
are important simply acquiring them does not automatically make
one a leader. As alluded to by the Samoan proverb “o le ala o le
pule o le tautua,” generally speaking a person does not apply for
leadership status once said characteristics are achieved, but rather he
or she is afforded leadership status by the community that they’re
serving through their work and the relationships established with that
community.
The concept of leadership needs to occur in our own language, way of
thinking and world-view first and foremost.
For many Pacific peoples service begins at an early age firstly with
fulfilling family duties, and followed perhaps by service to the church
and wider community. The same principles apply to Pacific consumer
leadership where leaders are recognized for their skills and abilities
as well as history of advocating on behalf of other Pacific consumers
i.e., the way to Pacific consumer leadership is through service to other
consumers.
Pacific consumer leadership is about being in a position to help others
or helping others with whatever you’re able to give.
I as a client trying to help others as well as myself, need
to be informed so that I am able to work with mainstream
psychiatrists, understood by nurses, occupational therapists
and support workers whether we are well or unwell. Gaining a
better understanding of these otherwise complex relationships
is important as a leader. If I don’t get it right and if I’m not brave
then I can’t help other consumers.
3.1.3 Other views of Pacific consumer leadership
For some, Pacific consumer leadership is about Pacific consumers
devising their own realities and means of achieving this. The pinnacle
for Pacific consumers in terms of leadership is ‘by-Pacific-consumerfor-Pacific-consumer
services. For others that peak is about Pacific
consumers being in places of power and being able to make decisions
[61] Bolden & Kirk, 2006: p2

that influence policy such as funders, planners and even within the
Ministry of Health. However for the majority of participants, family
and cultural values are essential ingredients of growing Pacific
consumer leadership.
3.1.4 Pacific consumer sector leadership participation
Participants were asked to rate the level of Pacific consumer
participation in leadership and governance roles within the sector. All
agreed that the level across the board was virtually non-existent, a
concern to many of those who provided feedback. While a number
of Pacific consumers are employed in various service user roles very
few, if any, are in leadership or management positions where they
can genuinely influence policy and service design. Although we have
exceptions of brilliance this needs to be the norm not the exception.
One person cannot be the all to everyone.
Pacific consumers are the missing (key) ingredient on the continuum
of sector leadership.
Some argued that on the rare occasion where a consumer is
appointed onto the board of an organisation…. the gesture is often
tokenistic where their views aren’t heard or taken seriously so they
become isolated and frustrated, unable to participate and contribute
fully to the decision-making activities of the board.
The majority of stakeholders also agreed that leadership participation
by Pacific consumers is needed right across the board from serviceuser/peer-specific
roles to managerial, senior executive and
governance positions. There may not always be enough consumerspecific
roles to go around so we need to look at other opportunities
within the sector and beyond.
3.2 Barriers and gaps
The possible explanations provided by the participants for the lack of
Pacific consumer leadership within the sector reflect similar themes
raised in the literature review. This section expands on some of those
key themes summarizing the barriers and gaps in Pacific consumer
leadership, as identified by the key stakeholders.
3.2.1 Sector commitment and support
The lack of action and genuine commitment from services and
the wider sector was identified by an overwhelming number of
participants as a significant barrier for Pacific consumer leadership
development. While there appears to be a willingness to grow Pacific
consumer leadership, the limited number of Pacific consumers in
leadership and governance roles suggests otherwise. It is unclear
exactly what the underlying reasons for this are but some providers
who participated in this study suggest that the lack of funding for
Pacific consumer-specific leadership initiatives, and the restrictive,
competitive nature of contracts, may be contributing factors.
43

44
3.2.2 Current leadership programmes
Some key consumer informants and the authors of this report
believe that current leadership programmes may be too advanced
for some, if not the majority of Pacific consumers, and that the
gap between, say peer support worker level and Le Va’s Emerging
Leader programme may be too vast. Therefore a bridging course may
need to be developed that would better prepare consumers for the
demands of more advanced courses. In addition, it may be useful
in future to clearly stipulate and encourage providers to support
consumers to apply for these programmes and mentor them for the
duration of their training. Alternatively some informants argued that
one or two positions within these programmes should be allocated
specifically for consumer applicants of Pacific descent.
At the moment the consumer leadership model in the sector is
very mainstream with little, if any, funding for Pacific.
3.2.3 Service structure and funding
Some key informants argue that the way in which services are
currently structured and funded may also act as barrier. Current
service delivery models tend to place doctors and other clinicians
at the top and therefore services are funded accordingly. We need
to develop service delivery models that put consumers and their
families first. However such models may be a bit too radical for the
sector and there may be some resistance. In addition, mental health
and addiction services are becoming more segregated from the
community and increasingly focused on technology, rather than the
people who use their services i.e. their customers. We know that
community-based and family-oriented services work best for our
people and we need services that reflect this.
Part of the battle for service users is taking mental health (and
addiction) services out of hospitals and into the community.
Figure 12: A key informant view on current service delivery model
Consumers &
families
Doctors & other
clinicians
Current
service
delivery
models
Service
providers

Figure 13: A key informant view on a consumer and family-centred
service model
Doctors & other
clinicians
Consumers &
families
Ideal
service
delivery
models
3.2.4 Workforce and training issues
Service
providers
A sufficient workforce that is culturally and clinically competent
remains a challenge throughout the mental health and addiction
sector, a view shared by many who contributed to this project. The
need for a skilled workforce for growing Pacific consumer leadership
cannot be underestimated, however at present there are not enough
workers to meet those needs. The lack of quality training that is
accessible and pertinent to growing Pacific consumer leadership is
another concern expressed by a number of participants. While several
leadership programmes are currently delivered in the mental health
and wider health sector, only a small number of Pacific consumers
participate in such programmes.
3.2.5 Lack of research and knowledge
While the notion of leadership is relatively well-researched and
discussed, knowledge pertaining to the unique qualities of mental
health and addictions consumer leadership is largely unknown, even
more so where Pacific consumer leadership is concerned. The lack
of research and limited understanding in this area of leadership is a
significant barrier argued a number of participants, and all agreed
that more research, such as the present one, and funding ring-fenced
specifically for this purpose is needed. The likelihood of increased
resources within the sector in the foreseeable future is slim. Therefore
we need to think critically and be innovative by investing more in
these types of initiatives. In addition, more in-depth investigation
into the challenges faced by providers when engaging in leadership
development for consumers, aside from funding issues and the
lack of a framework, is needed to truly understand the issues they
experience in this context. As well, an analysis of the cost-benefit
and return on investment of focusing on consumer leadership would
provide a beneficial boost for arguing the case of supporting such
initiatives.
45

46
3.2.6 Stigma and discrimination
Although programmes aimed at reducing stigma and increasing
mental health awareness, such as Like Minds, Like Mine have been
around for a number of years, based on comments from the majority
of the participants in this project, it would appear that such initiatives
have had little impact on changing the views of Pacific peoples about
mental health and wellbeing. Widespread stigma associated with
mental illness remains among Pacific communities and continues
to be a significant barrier for realizing consumer potential. As such,
some participants question the effectiveness of current mental health
awareness programmes in addressing mental health stigma among
Pacific communities and suggest more appropriate approaches need
to be explored and implemented as part of every provider’s (Pacific
and mainstream) service plan.
3.2.7 Youth consumer leadership
The lack of Pacific youth consumer leadership and participation in
consumer activities was a major concern for many of the project
participants. As widely-connected Pacific researchers, the authors
of this report can confirm the difficulties and challenges of finding
and engaging with young Pacific people or youth consumers, a
predicament familiar to many Pacific leaders and researchers in
the sector. The contribution and views of Pacific young people and
the need to develop Pacific youth consumer leadership cannot
be underestimated considering the youthfulness of the Pacific
population where over 50% are born in New Zealand. [62] Pacific youth,
particularly those born in New Zealand, experience high levels of
mental illness and other detrimental health effects compared with
their island-born and New Zealand counterparts. [63] As such it is vital
that Pacific young people and youth consumers are included and
contribute to leadership development. Mechanisms to grow Pacific
youth consumer leadership need to be reflected in this framework.
3.2.8 Leadership in addictions, forensic and CAMHS
There was some concern among a number of participants about
the absence of leadership within the area of addictions, despite
the increasing numbers of Pacific peoples presenting, particularly
for gambling related issues. Pacific (consumer) leadership within
addictions is in danger of being overlooked if, or when it becomes
lumped with mental health. Yet quite frankly there are unique
differences and challenges between mental illness and addictions
and we need to address this.
Even within mental health we need to realize and acknowledge the
various specialist and unique areas of mental health such as CAMHS,
youth, maternal and especially forensic mental health where a lot
of our men enter the system with high complex needs requiring
intensive and expensive treatment and care. We need to ensure that
their voices are also heard.
[62] Statistics New Zealand, Census, 2006
[63] Oakely et al, 2006

3.2.9 Ethnic-specific approaches
There needs to be recognition of ethnic-specific approaches to
consumer leadership development according to some key consumer
stakeholders. While Pacific nations share some universal values and
belief systems, they also demonstrate ethnically unique qualities
and nuances. Therefore the one-size-fits-all approach to leadership
development may not be as effective. This is particularly relevant for
Pacific consumers where many may feel alienated and disconnected
from their cultural support systems as a result of their mental illness.
Moreover, with growing evidence of ethnic differences in rates of
mental illness and other health determinants it may be timely to
explore ethnic-specific approaches as a model for service delivery and
leadership development. [64]
3.2.10 Pacific consumer voice
From a Pacific consumer perspective, Pacific consumer leadership will
allow the many voices of Pacific consumers across the country to be
finally heard with loudness and clarity.
For many years we’ve often been left in the dark with very little
opportunity to voice our opinions and concerns.
Pacific consumers are usually an afterthought in many ventures and
often the last ones to find out about things that are happening.
A robust pool of Pacific consumer leaders will allow consumers
to have the courage to speak up and advocate on behalf of other
consumers and their families. They can provide constructive feedback
and contribute positively to the Pacific workforce and services.
Service users are sometimes ignored and only consulted as an
afterthought. This needs to change.
3.2.11 Pacific consumer expertise
At present the number of Pacific consumer leaders with the expertise
to draw advice from is extremely limited with the few in existence
struggling to meet the needs and demands of the sector and
communities they serve. A strong Pacific leadership contingent with
wide-ranging opinions and expertise could be an alternative entity
that policy-makers, funders and planners as well as others could call
upon in any advisory capacity according to some project participants.
Others believe that Pacific consumers will add several dimensions to
sector leadership fuelled by their lived experience of mental illness,
technical nous and cultural knowledge. The prospect of change and
true innovation once Pacific consumer leadership is fully realized is
truly exciting.
[64] Ministry of Health, 2006
47

48
3.2.12 Community partnerships
A number of participants believe that consumer leadership is the
missing piece in the clinical and community/cultural relationship
puzzle. Consumer leaders are the links between services and the
communities, yet in practice they are often overlooked and ignored.
Services need to understand that we’re the ones who have the
relationships with our families and our communities so we need to
be at the decision-making table and not just an afterthought.
Pacific consumer leadership is going to build bridges – it will bring
people together and help a lot more Pacific consumers.
3.3 Pacific consumer leadership: some key areas
Key stakeholders were asked to describe some of the key success
factors of Pacific consumer leadership. Many of the themes that
arose from the consultations support some of the findings from the
literature.
3.3.1 Family
The family plays a significant role in leadership development
especially for Pacific consumers and many believe that it’s this
inherent way of being and operating is what differentiates Pacific
consumer leadership from other forms of leadership.
Most participants agreed that consumers who are well-supported by
their families are often those who recover earlier and stay well longer
which enables them to develop personally and professionally, a key
ingredient of leadership development. Family resiliency is an integral
part of Pacific leadership including Pacific consumer leadership
therefore family needs to feature quite prominently in any framework
intended for that purpose. As such, family must also journey along
with the consumer in his or her journey of leadership growth.
As a Pacific (consumer) leader you represent a whole lot of people,
not just yourself, your aiga who have supported and endured with
you on your journey of recovery and wellness. Some family members
also shared their concern with trying to overload consumers with
too much work and high expectations. They emphasized the need
to be mindful of this occurrence and to implement strategies such
as appointing mentors/supervisors, taking small steps etc, from the
outset to address these issues and minimize the chances of them
arising. Meaningful and continual communication and engagement
between family and consumers is also essential and in some cases,
especially where young people are concerned, parents might need
guidance in how to communicate with their children effectively.
It takes more than just one client to grow as a leader - they need
family support, which builds resiliency. In the context of this project,
the idiosyncrasies of family, church and community dynamics may not
always sit well alongside the rules and regulations of organizational
systems or government policy which are some of the challenges

a Pacific consumer leader will face and must ably negotiate on top of
the stigma associated with mental illness and addiction.
3.3.2 Being bold, passionate and visionary
A Pacific consumer leader needs to be passionate about what they
do according to a number of project participants. Passion develops
motivation and often people with passion are the ones with the
vision. Being a good communicator therefore is also vital, as they will
need to be able to translate the vision into reality and make things
happen.
We have individuals through passion and love for our Pacific peoples
who try to move mountains from the pennies that come their way.
That’s what passion does; it makes you forge ahead despite the
obstacles in your way.
Pacific consumer leadership is a new frontier with many unknowns.
Therefore those who wish to tread its path need to be bold and
brave.
A can-do attitude and ability to persevere and not give up when the
going gets tough is essential, as well as a good sense of humor.
These sentiments about Pacific consumer leadership were shared by
many of those who contributed to this project.
3.3.3 Respect and reciprocity
The notion of respect and reciprocity, values endemic to Pacific
peoples, and its importance to consumer leadership development,
was a recurring theme throughout the consultation phase. As a
leader, gaining the respect of others by respecting them also is
important if you wish to engage with communities effectively.
Most often in the very industry that demands it, respect is in short
supply.
Others believe that respect in this context means respecting and thus
valuing the knowledge and skills of consumers with lived experience
of mental illness (and addiction) and what they have to offer.
3.3.4 Mentorship and peer support
Many participants described mentorship and peer support as a useful
vehicle for leadership development among Pacific consumers.
49

50
It is important that we have role models that we can relate to and
ask for direction when we need to. Unfortunately we don’t have
enough, if any Pacific consumer youth leaders or any consumer leader
for that matter, to go around because matching, say a young Samoan
leader to a young Samoan consumer would be ideal but there just
aren’t many out there.
Being amongst your own people who understand what you’ve been
through and share your passion helps build your confidence.
Matua and other Pacific leaders in the sector are key providers of
leadership guidance for consumers according to many participants.
The role of matua is especially important for spiritual growth and
cultural grounding. One Pacific consumer leader also felt that the few
Pacific consumer leaders in existence today and any future leaders,
need to be protected and cared for. We need to make sure as a sector
and community that we don’t overload and isolate ourselves from
them – we need to look after them.
3.3.5 Pacific-specific consumer and family networks
Another avenue of peer support and mentorship is through Pacific
consumer groups linked with the wider regional and national
consumer networks in New Zealand. The collective efforts of Pacificspecific
consumer and family groups that provide support and
advocate on behalf of their members and other consumers and
their families was identified as an important element of fostering
Pacific consumer leadership. Two Pacific-specific consumer groups
participated in this project: Northern Regions Pacific Consumer and
Family Forum, from Auckland and Te Anau Tamarangi, a Cook Islandsspecific
consumer group based in Porirua.
Other Pacific-specific consumer groups may exist throughout New
Zealand. Due to time-constraints it was not possible to visit and thus
mention them all.
New Zealand’s first national Pacific consumer and family recovery
conference in 2009, funded by Le Va, launched a National Pacific
Consumer and Family Forum formed from previous regional networks.
This national forum works alongside sector workforce development
agencies such as Te Pou, Le Va, the Werry Centre, Te Rau Matatini,
Matua Raki as well as local DHBs, to advance consumer initiatives.
3.3.6 Working with others
An effective Pacific consumer leader needs to be able to work
alongside, and learn from other leaders while simultaneously
engaging with other consumers and their families, many of whom
come from ethnically and culturally diverse backgrounds. While
an academic background is advantageous particularly at senior
leadership level, lived experience is equally crucial to the role. In
addition, a good Pacific consumer leader will be able to engage

with people from diverse backgrounds outside the sector, as well as
government and NGOs. The ability to navigate in diverse situations is
essential and this needs to be reflected in the Framework.
3.3.7 Partnerships with Tangata Whenua
In recognition of Te Tiriti and tangata whenua status of Maori,
combined with common moana-nui-a-kiwa ancestral origins and
beliefs, forming partnerships and linkages with tangata whaiora
or tangata motuhake is considered essential for Pacific consumer
leadership development. In addition, the increasing number of
Pacific peoples, especially youth, who share M ori heritage as
evidenced in recent census, provides further support for the need
to work alongside M ori. While the specifics of such a relationship
requires further exploration, many participants, especially consumers,
felt that lessons could be learnt from similar experiences undertaken
by tangata whaiora in their ongoing journey of leadership growth and
influence.
3.3.8 Sector-wide support and policy
Support from the sector at provider/local, regional and national
level is essential for the implementation of the Framework. The
Pacific Consumer Leadership Framework should fragrance through
all organizations, DHB policy and national strategies if we’re serious
about developing Pacific consumer leaders. A number of stakeholders
felt that policies and strategies should explicitly state the need to
address Pacific consumer leadership and that resources be allocated
specifically for this purpose otherwise there is a danger that
consumers will again be left at the bottom of the heap. Consequently
developing indicators and outcome measures to gauge the impact the
Framework may have on Pacific consumer leadership and the sector
was highlighted as crucial.
A number of participants also stated the importance of regional
and national alignment of Pacific consumer initiatives to ensure
consistency and standard practice.
3.3.9 Level of implementation and practicality
Pacific consumer leadership needs to occur at all levels of service
delivery and workforce development from service inception and
design, planning and funding to delivery, according to most of the
participants, Therefore the Framework needs to be practical enough
to have broad appeal to providers, funders and policy-makers. At
the same time, from a consumer perspective, the Framework needs
to consider the consumer’s individual circumstances and level of
wellness, and while some key stakeholders expressed a desire for
the Framework to focus on middle to upper ranges of leadership
capability, the overwhelming consensus from Pacific consumers
indicate that the Framework needs to be inclusive of all service users,
their families, youth, as well as those in addictions including
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52
gambling. We cannot forget those who are unwell or locked up. They
are also part of the Framework and need to be supported toward
recovery and leadership growth.
3.3.10 Specialist Pacific consumer leadership panel
The establishment of a panel or group comprised of relevant experts
and advisors with diverse skills to oversee the implementation,
review and further development of the Framework received
widespread support from a number of key informants. This specialist
group would also be responsible for monitoring and gauging the
progress of Pacific consumer leadership growth within the sector.
Although the role and composition (clinical, cultural, consumer and
technical expertise) of such a group requires further investigation,
initial views indicate that this group in conjunction with like-minded
partners and providers will play a critical role in ensuring the success
of this Framework and Pacific consumer leadership development.
3.3.11 Pacific consumers and leadership in general
While this project focuses primarily on Pacific consumer leadership
within the sector a number of key stakeholders felt that ….we
need to get away from our current way of thinking that whenever
Pacific consumer leadership is mentioned we automatically think of
consumer advisor roles or peer support positions. No doubt these
roles are important, but we need to change our attitudes and thought
patterns and begin thinking about Pacific consumer leadership in a
much broader sense.
Leadership is about wherever that person may be, he or she is having
some influence and contributing somewhat in whatever capacity or
situation they find themselves in.
True Pacific consumer leadership is when Pacific consumers are
more visible and employed as managers, funders, board members,
researchers, clinicians both within the mental health and addictions
sector and elsewhere.
3.3.12 A case study
To gain further understanding of the complexities of Pacific consumer
leadership and the type of environment that is conducive to growing
Pacific consumer leaders, the example of a respected colleague
currently in a consumer advisor role, was considered.
The key to success for an environment that fosters consumer
leadership was described as the unbridled support, belief,
connectedness and shared values and common vision between the
consumer, clinical, cultural and corporate aspects of their service.
The adapted 4C version of Mariner’s [65] 3C model is a useful
illustration of this environment. In addition, according to this
[65] Mariner, 2008

Board
Management
Staff
colleague, that level and type of support filtered through to senior
management and governance level and was a key factor in his
opinion, of his success. Essentially it’s a 3D representation of the
adapted 4C model. Mariner’s 3C and the revised 4C model is an
approach pertaining to the relatively controlled environment of the
workplace, but the core principles and applications of the models can
be adapted and extended to consider the real world or holistic nature
of the home or community setting, in relation to Pacific consumer
leadership development.
Figure 14: 3D version of the 4C model
Clinical
Cultural
Corporate
Cultural
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4. Pacific Consumer
Tiare Ruperupe
Leadership Framework
4.1 Overview
The Framework outlines an approach that may assist service providers
with supporting the development and growth of Pacific consumer
leadership within their organizations. It acts as a guide or reference
point for individuals, families and organizations, as well as
policy-makers involved in service design and policy development.
The Framework is designed to consider as wide and broad a scope of
consumer experience, level of wellness and capabilities within the
mental health and addiction sector as possible, mindful that each
person is at a differing stage of the recovery journey. Some degree of
flexibility and fluidity therefore must be employed in its interpretation
and implementation.
As a living document it is envisaged that the Framework will be
reviewed continuously and adapted to the changing needs of the
sector.

4.2 Tiare Ruperupe
The Tiare Ruperupe (flourishing flower) leadership model is contained
within two parts: the first, the tiare or flower, provides a bird’s eye
view guide that sits above or precedes the second part, the tumu or
stem. The tumu is a more detailed, individualised description of the
Framework.
The tiare proposes some broad examples of core companions,
represented by each petal (can be increased or decreased and
renamed to suit), which are highly recommended for Pacific
consumer leadership success. The purpose of the tiare, akin to the
Fonofale model, is to serve as a reminder of the important role and
influence other key areas beyond the walls of an organization, play in
fostering flourishing Pacific consumer leaders. It is intended as a point
of reference to ensure that key tangible areas in the person’s life,
through self-reflection and questioning, underpins their leadership
journey. Figure 13 describes this concept.
Figure 15: The Tiare Ruperupe Model - Part 1 Tiare
mental health & health services
mentors & support groups
education/training institutions
employer/place of work
PCL
church & other social settings
consumer
family/the home
NGO & government agencies
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Description
The centre
• PCL - Pacific consumer leadership
The Petals
• Consumer: the person or individual.
• Family/the home: immediate and /or extended family (parents, siblings
etc),the home environment.
• NGO & government agencies: organizations other than MH or health providers.
For example WINZ, IRD, budgeting services etc.
• Church & other social settings: refers to to the church and/or places where the
person engages in social activities e.g.non-church youth group, sports club etc.
• Education/training institutes: education and training are crucial for leadership
development. Training can be in-house or offset, with a private training provider
or public education facility.
• Mentors and support groups: mentors and /or support groups, such as the
consumer regional network or whatever thay may be are also an important part
of the journey.
• Mental health & health services: PHO’s, MH and addictions services etc.
• Employer/place of work: does the person work and if so how important or
what role do they play in leadership development?
Note: each individual has unique needs therefore some of the above may vary
accordingly - these are some broad examples and may be adapted to suit specitic needs.

4.3 The Framework (Tumu)
The Framework (Tumu) is based on Sherry Arnstein’s Ladder of
Participation model which alludes to notions of tokenism, power,
non-participation etc, ideologies which are still present today, as
evidenced by the feedback from consumers during the consultation
phase.
The model recognizes the limited opportunities Pacific consumers
currently experience in leadership involvement and participation.
When the Framework is used to indicate the current status of
Pacific consumers in terms of leadership, the majority would be
congregating at the lower left quadrant. The aim of the Framework
is to provide a map or guide to support the development of Pacific
consumer leadership participation toward the middle to upper right
regions of the Framework.
For ease and practical purposes a column flanking the right side of
the Framework lists some suggested support systems, programmes,
reports and initiatives that are useful when using this guide.
It is important to note that the Framework is underpinned by the
core Pacific values and cultural beliefs and practices as outlined, but
not exclusively, by the Sei Tapu Pacific Mental Health and Addiction
Clinical & Cultural Competencies Framework. [66]
[66] Pulotu-Endemann et al. (2007). Seitapu: Pacific mental health and addiction cultural and clinical framework. Te Pou: Auckland
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FTable 5: PACIFIC CONSUMER LEADERSHIP DEVELOPMENT FRAMEWORK
SELF-BELIEF
• Pacific Health Leadership Programme
(Ministry of Health)
• The Executive Leadership Management
Programme (Blueprint Centre for Learning)
• MBA/other leadership programmes
• Involvement with consumer groups
(eg. Northern Regions Pacific Family and
Consumer Forum)
• Real Skills
4. SELF-DETERMINING
SELF-DETERMINING: Consumers have entire ownership and
responsibility for planning, policy-making and/or full managerial and
governance power. Consumers have clear majority on decision-making
bodies and are delegated powers to make decisions.
• Roles may include governance board membership, management, team
leader, CEO etc. Consumer has autonomy, high self-awareness and
increased sense of accountability. Is able to take on both mainstream,
Pacific, general and consumer-specific roles. The pinnicle of this stage
may be illustrated by the formation of Pacific consumer owned and
managed services.
SELF-
AWARENESS
PACIFIC VALUES & PROTOCOLS (SEITAPU)
SELF-
MANAGEMENT
• Consumer Advisor Training/Consumer leadership
bridging program
• Mental Health Certificate
• “Like Minds Like Mine” initiatives
• Le Va MH&A Leadership Programme
• Skilled and caring key workers
• Family, youth and/or church groups
• Involvement with consumer groups (eg. Northern
Regions Pacific Family and Consumer Forum)
• Real Skills
SUGGESTED KEY SUCCESS FACTORS-RESOURCES-INITIATIVES
Stages 3 & 4 are
primarily where Pacific
consumer leadership
participation is
severely lacking.
3. PARTNERSHIP
PARTNERSHIP: power is redistributed through
negotiation process; there is shared planning
and decision-making through joint committees.
Decision-makers select those whom they
deem worthy to sit on committees that make
decisions but power remains with them.
• Roles may include consumer advisor, peer
support worker or trainer etc. There may be
more responsibilities given to the consumer.
PERSONAL
INTEGRITY
ENGAGEMENT PARTICIPATION DEVELOPED ADVANCED
LEVELS OF LEADERSHIP
• PEER Support Training
• Consumer Advisor training
• Wellness Recovery Action Plan (WRAP)
• In-house development training workshops
• Involvement with consumer groups (eg. Northern
Regions Pacific Family and Consumer Forum)
• Skilled and caring key workers
• Family, youth and/or church groups
• Peer support/mentorship/role modeling
• Real Skills
CONSULTATION: a legitimate step in the
right direction but often a “window-dressing”
ritual for the power-holders. This stage is
a crucialfirst-step for the disempowered to
become engaged in legitimate participation.
Often a one-way flow of information with no
channel to present feedback
• Roles may include consumer advisory positions,
and activities may include membership or
participation in organizational activities, fono’s etc.
For some consumers
reaching this level may
be sufficient for their
needs Others may
aspire for further
development.
CULTURAL CONTEXT | TECHNICAL CONTEXT | LIVED EXPERIENCE
2. CONSULTATION
DRIVE FOR
IMPROVEMENT
RESILIENCY
• Appropriate Cultural & Clinical Assessments (use
Pacific models of care such as Fonofale, Te Are
Turama O Mao ‘a etc)
• Personalised Care, Risk Management, Support & Goal
Plans etc
• Skilled and caring keyworkers
• Family, youth and/or church groups
• Involvement with consumer groups (eg. Northern
Regions Pacific family and Consumer Forum)
• Real Skills
NON-PARTICIPATION: at this level the aim is to cure or educate the
disempowered with very little or no thoughts around involving them
whatsoever in any decision-making. The detrimental effects of such
treatment are confidence-breaking and cause many set-backs in
consumer’s recovery.
• Limited involvement or participation in most decision-making processes,
activities; responsibilities may be relinquished to others
1. NON-PARTICIPATION
POLICY, GOVT, REGION, NATIONAL, PROVIDER, SECTOR SUPPORT PACIFIC MODELS OF CARE, VALUES, CULTURE, COURAGE,
PASSION SHARED VISION, ETC
FAMILY, YOUTH, CAMHS, FORENSIC,
ADDICTIONS, TANGATA WHENUA
Unwell RECOVERY
Living well

Stages of Leadership participation
Engagement: non-participation
This stage is described as the point at which
consumers make first contact or re-engage with
mental health and addiction services. For Pacific
consumers this may often be in a state of severe
unwellness, with high complex needs. Most
consumers at this level may have limited or nonexistent
participation in any form of decisionmaking,
self-determination or leadership
processes because of their state of unwellness.
• Suggested Support or Resources
It is essential that the appropriate support
systems and/or resources are available and
utilized to ensure the optimal success. The
following suggestions are guides only:
• Appropriate assessment tools utilized to
determine treatment approaches
• Implement personalized Care, Risk
Management, Support Plans & Goal Plans
etc
• Use of appropriate models of care(eg.
Sei Tapu, Te Are Turama O Mao’a,
CAHMSapproaches etc)
• Competent matua, cultural workers, peer
support workers etc Consumer forum
support (eg. Northern Regions Pacific
Family and Consumer Forum)
• Mentoring/peer support (matched peer
support if possible).
• Key Success Factors
This section describes some of the key factors to
ensure the success of consumer growth.
• Skilled, passionate and competent
(clinically and culturally) key/support
workers
• Strong collaboration and
regularcommunication betweenmultidisciplinary
teams, consumer and family
members (where appropriate)
• Patience and passion as recovery takes
times
• Family and the wider community
haveincreased awareness of mental
illnessand addictions Stigma, prejudice
and discrimination are eliminated or at the
very least minimized Adequate resources
andorganization-wide support
• Personal Qualities
The following qualities relate to the consumer:
• Some degree of self-awareness
andunderstanding is essential. In extreme
cases where the client is unwell refer
to their care plan or similar that may
have been developed earlier to gain
clarification as to what needs to be done
in this situation. The plan may include the
involvement of family members, friends or
significant others.
• Desired outcomes
These outcomes are indicative only and are
based on feedback from key stakeholders,
the literature and the personal experiences
of the authors. In reality the outcomes are a
collaborative effort between the consumer, the
key worker and associated support systems.
• Consumers receive effective care and
treatment
• Consumer shows signs of becoming well
• Early evidence of collaboration between
worker(s) and consumer
• Relationships are established or
re-confirmed
• Small steps toward wellness are observed
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Participatory: consultation
The Participatory stage describes the crucial first
step in legitimate participation with the powerholders.
Often good intentions abound but crucial
decisions are still determined by those other than
the consumers. There may be reluctance from
others, including loved ones who may not wish
to delegate too much responsibility. However this
may also be an opportunity to begin delegating
basic responsibilities and decision-making
processes with support and encouragement.
• Suggested Support or Resources
• In addition to those described in the
Engagement stage the WRAP plan may
be introduced at this stage
• Consumers may be able to participate
in in-house training workshops that are
concomitant with their skills and abilities
and level of wellness
• Consumers are supported to join
organizational groups such as Pacific
fono groups and participate in various
activities. Some may be allocated
responsibility for basic tasks and
activities; and Consumer forum support
(eg. Northern Regions Pacific Family and
Consumer Forum)
• Mentoring/peer support (matched peer
support if possible)
• Key Success Factors
• Skilled, passionate and competent
(clinically and culturally) key/support
workers
• Strong collaboration and regular
communication between multi-teams,
consumer and family members (where
appropriate)
• Family and the wider community have
increased awareness of mental illness
and addictions
• Stigma, prejudice and discrimination
are eliminated or at the very least
minimized
• Opportunities for emerging leaders are
created
• Patience and passion as recovery takes
times
• Adequate resources and organizationwide
support
• Reflective listening, discussion and
perhaps collaborative clinical notewriting
may be introduced
• Personal qualities
• Some evidence of self-awareness, selfbelief
and understanding is clear
• Personal accountability and integrity
should also be apparent by this stage
• Some level of willingness to participate
autonomously in decision-making
process is shown
• Desired outcomes
• Consumer sets own goals and plans in
collaboration with their key worker or
support worker as a result of his or her
desire to develop further
• Consumer displays some level of selfmanagement,
autonomy. May express
wish to take on part-time voluntary or
paid work if they haven’t already
• Consumer appears to be well and is
able to maintain wellness and good
relationships over longer periods
• Consumer is able to take responsibility
and perform basic to medium-level tasks

Developed: partnership
At this stage consumers will begin to display
emerging basic leadership qualities and may be
appointed in various consumer-specific positions
as consumer advisors/advocates or become Peer
Support workers. Some may go on and become
PEER support trainers themselves. Others may be
appointed to committees or boards that make
decisions.
• Suggested Support or Resources
• WRAP plan implemented earlier in still in
place but may need reviewing as well as
other personalized plans
• PEER Support Training workshops are
available
• Consumers participate in in-house training
workshops that are concomitant with their
skills and abilities and level of wellness
• Organizational and sector activities that
contribute to consumer development are
available
• Mental Health Certificate and Like Minds
Like Mine consumer initiatives
• Le Va’s Mental Health and Addictions
Emerging Leadership Programme
• Consumer forum support (eg. Northern
Regions Pacific Family and Consumer
Forum)
• Key Success Factors
• Skilled, passionate and competent (clinically
and culturally) key/support workers
• Strong collaboration and regular
communication between multi-disciplinary
teams, consumer and family members
(where appropriate)
• Family and the wider community have
increased awareness of mental illness and
addictions
• Stigma, prejudice and discrimination are
eliminated or at the very least minimized
• Opportunities for emerging leaders are
created
• Patience and passion as recovery takes
times
• Adequate resources and organisational
support
• Collaborative partnerships between key/
support workers and consumers
• Personal qualities
• High level of self-awareness and
understanding, and personal accountability
• Willingness to develop personally and
professionally
• Able to work autonomously or as part of a
team
• Performs well in core areas, but may need
some development in one or more areas
or complex key actions. It is desirable
that some form of formal schooling
or undergraduate level competence is
achieved at this stage
• Desired outcomes
• Consumer positions are filled and increased
• Consumer input is welcomed and
acknowledged
• Consumer representation on boards or
decision-making committees is evident
• Consumer driven initiatives or strategic
plans are developed within the organization
or service
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Advanced: self-determining
This stage could be described as the pinnacle
of Pacific consumer leadership whereby
the individual is able to assume any role
(governance, management etc) within
mainstream or Pacific organizations within and
across sectors. In relation to the mental health
and addictions sector some key stakeholders
in this study argue that the reality of Pacific
consumer-owned and run services is a key
indicator of Pacific consumer leadership success.
In addition, at this stage of development
other leadership styles such as transactional,
relational, transformational and charismatictransformational
may come to the fore. [67]
• Suggested Support or Resources
• Pacific Health Leadership Programme
(Ministry of Health)
• The Executive Leadership Programme
(Blueprint Centre for Learning)
• MBA/ or other leadership programmes at
various tertiary institutions; and Consumer
forum support (eg. Northern Regions Pacific
Family and Consumer Forum)
• Key Success Factors
• Collaborative partnerships with other
senior staff are established
• Adequate and relevant qualifications and
skills are attained
• Ongoing professional development
• Sector support
• Mentoring and supervision
• Personal qualities
• High level of self-awareness, self-belief,
self-management and personal integrity
and accountability
• Comprehensive understanding of financial
management systems, policy, infrastructure
and organizational development
• Willingness to develop personally and
professionally
• Able to work autonomously or manage a
team
• Tertiary education (ideally graduate) and
management experience desired
• Be passionate and visionary
• Desired outcomes
• Consumers assume general managerial
positions
• Consumers’ representation and participation
on governance boards are more
pronounced and less tokenistic
• Consumer driven initiatives or strategic
plans are developed within the
organization or service
• The consumer workforce is increased
• By-Pacific-for-Pacific consumer led and
managed services are established
[67] Pulotu-Endemann et al. (2007). Seitapu: Pacific mental health and addiction cultural and clinical framework. Te Pou: Auckland

5. Conclusion &
Recommendations
The overwhelming majority of participants agreed that developing
and growing leadership among Pacific mental health and addictions
consumers and their families is a major priority.
A framework for developing Pacific consumer leadership was
identified as a crucial component for nurturing leaders within this
cohort. The contribution of Pacific consumers as leaders within
the sector is an exciting prospect and provides the opportunity for
innovation and breaking new ground.
Key government and DHB documents emphasise the need for
Pacific consumer input into service design and delivery, however the
shortage of Pacific consumers in positions of influence, governance
and management roles means that the voice of Pacific peoples
from a service-user perspective goes largely unheard. Growing
and strengthening the Pacific consumer workforce and leadership
numbers is alluded to in various strategic documents and is
recognized as a key contributing factor to improved service delivery
and increased access rates.
While leadership development models or frameworks are varied
and useful, these tools are of little worth without the support and
commitment from providers and leaders within the sector, to drive
its implementation and inclusion in policy. The success of frameworks
is also reliant on the firm belief from everyone that investing in
initiatives like this Framework; in the long term is a cost-effective
means of addressing many of the workforce development and service
improvement needs of the sector.
For most participants who were involved in this project, Pacific
consumer leadership development was largely un-chartered territory,
and for some perhaps this still remains the case. However if anything
the hope is that this project will have, at the very least generated
debate and action around this key, often misunderstood subject.
And by no means do things end at this juncture; rather it is
anticipated that this project will have provided a beginning point for
further study into this all-important yet poorly understood subject
especially in relation to Pacific consumers and their complex needs.
5.1 Timeframes and level of implementation
Timeframes have not been set for the different stages of leadership
participation, as each person’s own journey of recovery differs. The
Framework is designed to cater for the broad spectrum of consumer
experience, background and level of wellness therefore
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64
any milestones and when these are achieved is self-determined
and should be discussed between the client and staff member. The
Framework is also cyclical and can be repeated as desired, should a
client experience relapse. It must be noted that while the Framework
has four stages of leadership some consumers may happily wish to
remain once Stage 2 or 3 is reached i.e. not all consumers may want
to reach Stage 4.
5.2 Monitoring & Performance Indicators
As one of the recommendations in this report, the need for
monitoring the effectiveness and impact of this Framework through
the development of performance indicators and outcome measures
is important. like this Framework; in the long term is a cost-effective
means of addressing many of the workforce development and service
improvement needs of the sector.
For most participants who were involved in this project, Pacific
consumer leadership development was largely un-chartered territory,
and for some perhaps this still remains the case. However if anything
the hope is that this project will have, at the very least generated
debate and action around this key, often misunderstood subject.
And by no means do things end at this juncture; rather it is
anticipated that this project will have provided a beginning point for
further study into this all-important yet poorly understood subject
especially in relation to Pacific consumers and their complex needs.
5.3. Recommendations
The following recommendations are made based on the findings from
the literature review and stakeholder consultations. Therefore, it is
recommended that:
• The Framework be adopted and incorporated into key strategic and
policy documents and that further planning, funding, contracting
and delivery of mental health and addictions services is
undertaken in accordance with this Framework
• Pacific consumer workforce development is prioritised and
explicitly stated in key workforce development plans and
documents
• Pacific leadership initiatives and workforce development, as
guided by the Framework and other key policy documents, are
aligned and consistent regionally and at national level
• A follow-up phase and further development of the Framework is
undertaken. This phase could involve the development of key
indicators and outcome measures, a resource kit and the
implementation of a pilot programme to gauge its effectiveness
• Scholarships or places in current Pacific leadership training
programmes are created for Pacific consumers and that emerging
Pacific consumer leaders who participate in such programmes
receive appropriate supervision and mentorship
• A needs assessment and/or stock-take of the Pacific consumer

workforce and profile in Aotearoa New Zealand is undertaken
• A Pacific-specific peer support, consumer advisor training and a
bridging leadership training programme for Pacific consumers is
developed and implemented by Pacific for Pacific
• A specific Pacific training package is developed to imbed Pacific
peer support philosophy within the workforce and to train and
employ specific Pacific consumer auditors to maximize service
improvements
• A segment or module on Pacific consumer leadership be included
in existing and future Pacific and non-Pacific leadership training
courses within the sector
• Current management practices and service structures are
re-configured to ensure Pacific consumer advisors sit alongside
their managing peers and other advisors;
• More by-Pacific-consumer-for-Pacific research initiatives are funded
and resourced adequately
• A review of current mental health stigma-reduction and
awareness- raising marketing strategies and its effectiveness in
reaching Pacific communities is undertaken
• A cost-benefit analysis of return-on-investment on projects such as
the present one is conducted
• A National Pacific Recovery Conference is held yearly and hosted
rotationally by each region
• Financial sustainability to develop the four regional and national
Pacific Consumer and Family Forums is ensured
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66
6. Appendices
Appendix 1: References
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Manukau City: CMDHB
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Faleafa, Monique & Lui, David. (November 2005). A Preliminary Report on Outcomes Measures for Pacific
Island Peoples: A Report prepared for MH-SMART Te Pou Research Programme. Auckland: Te Pou
Freire, Paulo (1970). Pedagogy of the Oppressed. New York: Herder and Herder
Hansen, C. (2003). Strengthening our foundations: service user roles in the mental health workforce.
Wellington: Mental Health Commission. Downloaded on 7 July 2008 from http://www.mhc.govt.nz/
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Milo-Schaaf, K. & Hudson, M. (2008). Negotiating space for indigenous theorizing for Pacific mental
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Health and Addiction Workforce Development Plan 2006-2009. Wellington: MOH.

Ministry of Health (June 2005). Te Tahuhu – Improving Mental Health 2005-2015: The Second New
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Northern District Health Board Support Agency (October 2004). Northern Region Mental Health &
Addictions Services Strategic Directions 2005-2010. Auckland: NDSA & the Network North Coalition.
Orwin, D. (July 2008). Thematic review of peer supports. Wellington: Mental Health Commission.
Peterson, Debbie et al. (2004). Respect Costs Nothing: A Survey of Discrimination Faced by People with
Mental Illness in Aotearoa New Zealand. Auckland: Mental Health Foundation of New Zealand.
Pulotu-Endemann et al. (2007). Seitapu: Pacific mental health and addiction cultural and clinical
framework. Te Pou: Auckland
Standards New Zealand (2001). The National Mental Health Sector Standard. Wellington: SNZ.
weLEAD Online Magazine. (2001). Four levels of leadership participation. Downloaded on 11 July 2008
from http://www.leadingtoday.org/Onmag/2001%20Archives/june01/participation.html
Wood, M. and Gosling, J. (2003). Is the NHS leadership qualities framework missing the wood from the
trees? Centre for Leadership Studies: University of Exeter. Downloaded 2 May 2008 from http://centres.
exeter.ac.uk/cls/research/abstract.php?id=21
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Appendix 2: Participating organisations
Over 50 participants from a wide range of backgrounds including Pacific consumers, family members,
managers, clinicians, were involved in this project representing over a dozen organizations.
Focus groups and feedback sessions were held with:
• Pacific consumers and family members (3 focus groups)
• Pacific youth consumers
• Pacific Auckland regional stakeholder group
• Pacific providers (both NGO and DHBs)
Participating individuals and organizations include:
• Affinity Services (Auckland)
• Dr. Monique Faleafa, Le Va (Auckland)
• Dr. Francis Agnew, Lotofale (Auckland)
• Bruce Levi, Takanga a Fohe (Auckland)
• Kirk Mariner, CMDHB (Auckland)
• Cornwall House, Early Intervention Prevention, ADHB (Auckland)
• The Cottage (Auckland)
• Northern Regions Pacific Consumer and Family Forum (Auckland)
• Barry Afaaso & Siosinita Alofi, Kari Centre, ADHB (Auckland)
• Platform (Wellington)
• Case Consulting Ltd (Wellington)
• Penina Health Trust (Auckland)
• Challenge Trust (Auckland)
• AMHS (now known as Connect Supporting Recovery)
• David Lui, Consultant, Focus on Pacific Ltd (Auckland)
• Te Anau Tamarangi, Vakaola (Wellington)
• TUPU Pacific AOD services, Takanga a Fohe, WDHB, (Auckland)
• Malaga a le Pasifika Services, Takanga a Fohe, WDHB (Auckland)

Appendix 3: Stakeholder consultation information
Pacific Consumer Leadership Framework Project 2008
Key Informant Interview
Malo e lelei “ Kia Orana “ Talofa Lava “ Faka’alofa Lahi Atu “ Ni
Sa Bula“ Ia Orana “ Taloha Ni “ Kia Ora
You are invited…
You are invited to participate in the Pacific Consumer Leadership Framework Project 2008. The project is
aimed at developing a framework to support Pacific consumer leadership and participation within the
mental health and addictions sector in the Auckland region.
Your involvement…
We would like to interview you to get your views on whether there is need for this framework;
discuss some of the critical factors underpinning this framework to ensure its success; and discussion
concerning Pacific consumer development overall. The interview may be in person or over the phone
and should only take an hour at most. The interview can be conducted at a time and location that is
most convenient for you. Once you accept the invitation we will contact you to arrange a time and
place to meet. A questionnaire will be forwarded to you prior to the scheduled meeting. Interviews
will commence with a brief introduction and background information about the project, as well as the
completion of a consent form. Please note that with your permission the interviews may be audiorecorded,
and you may choose to leave at any time during the session.
Benefits to you…
By agreeing to participate in this project you are contributing significantly to the development and
growth of Pacific mental health and addictions service users in Aotearoa. Ultimately, this project, which
is part of a range of initiatives, aims to improve the health and wellbeing of Pacific consumers and their
families by ensuring that the services they receive are effective and beneficial.
Yes I’m interested!
If you’d like to participate in the project and would like more information please do not hesitate to
contact us at the details below.
Tai Richard
Project Manager
Richarri Ltd
Ph/Fax: +64 9 276 0872
Mob: 021 915 583
Email: tai@richarri.com
PO Box 22443
Otahuhu, Auckland
Lina Samu
Senior Researcher
Richarri Ltd
Ph/Fax: +64 9 276 0872
Mob: 021 143 4996
Email: slamu@xtra.co.nz
PO Box 22443
Otahuhu, Auckland
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Dear
i n v i t a t i o n
Consumer Focus Group
We are building a Pacific Consumer Leadership Framework
You are invited!
You are invited to participate in a fono/focus group meeting to share your views on this topic. The
purpose of project is to build a framework to support Pacific consumer leadership development and
growth in the mental health and addictions. This is your opportunity to be heard on how we can develop
What will happen?
Where
Whariki Family & Consumer House
54 Carruth Road
Papatoetoe
When
Wednesday, 16 April 2008
6pm – 8pm
A small focus group meeting, facilitated by Tai Richard and Lina Samu will take place. You will be asked
some questions about how we can develop this framework. Your answers may be recorded but will be
kept confidential.
Dinner & Mea Alofa
Dinner will be provided, and a small mea alofa to acknowledge your contribution to this important work!
RSVP
Thank you for taking the time to consider this invitation. For catering purposes, please let us know as
soon as possible whether or not you’re planning to attend. We look forward to seeing you there. If you
would like more information or would like transport to this meeting please do not hesitate to contact us.
Tai Richard
Project Manager
Richarri Ltd
Ph/Fax: +64 9 276 0872
Mob: 021 915 583
Email: tai@richarri.com
PO Box 22443
Otahuhu, Auckland
Lina Samu
Ph/Fax: +64 9 276 0872
Mob: 021 143 4996
Email: slamu@xtra.co.nz
CPO Business Centre
Otahuhu, Auckland 1640
Level 1, Suite 4,
350 Great South Road,
Otahuhu, Auckland 1640

Key Informant Questionnaire
1. What is your role/ involvement do you have in the mental health & addictions sector?
2. How would you rate the current status or levels of participation by Pacific consumers at leadership
level in the mental health and a ddictions sector? (circle one). What are the gaps in current sector
initiatives for Pacific consumers?
Very poor Poor Okay Good Excellent
3. What is your view/ are your views about the roles that Pacific consumers might have in sector
leadership?
4. What are the barriers if any, to Pacific consumers being successful in leadership roles?
5. If we were to utilise a SWOT (Strengths. Weaknesses, Opportunities, Threats) analysis graph, what
would be your top five for each section with regards to Pacific consumers being in leadership roles?
6. What initiatives, groups, organisations, reports/ findings or models are you aware of that would help
support Pacific consumers success in mental health and addictions sector leadership?
7. What initiatives, if any, is your organisation involved with or is implementing that supports Pacific
consumer development and leadership?
8. What Pacific or general leadership programmes or professional development initiatives does your
organization provide? And what is the level of consumer participation in these programmes?
9. What are the key success factors of Pacific consumer leadership? Do you think there is a need for a
Pacific consumer leadership framework?
10. Once developed, at what level do you think should this framework be targeted at? (ie. beginners,
advanced etc).
11. What type, or how much support and/or resources is or are required to implement this framework?
How can we gain sector-wide support for this framework?
12. Any other comments/contributions to this matter of building a Pacific Consumer Leadership
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Focus Group Topic Guide for Providers
Malo e lelei ā Kia Orana ā Talofa Lava ā Faka’alofa Lahi Atu ā Ni Sa Bula
ā Ia Orana ā Taloha Ni ā Kia Ora
Thank you for agreeing to participate in this project which is aimed at developing a framework for Pacific
consumer leadership in the mental health and addictions sectors in Aotearoa. The purpose of this focus
group discussion is to get your views and awareness of Pacific consumer development and leadership
in the current environment. It will include discussions on existing consumer development initiatives and
any gaps if any, as well as seeking your thoughts and ideas for developing a framework that will support
Pacific consumer leadership in the sector. The following questions are intended as guides that will assist
with the discussions.
1. How would you describe or rate Pacific consumer involvement at strategic, leadership level in the
sector? Within your organization? (i.e. do you think that there is sufficient Pacific consumer input in
service design and delivery?)
2. What types of programmes or initiatives does your organization have for Pacific consumer
development?
3. What Pacific or general leadership programmes or professional development initiatives does your
organization provide? And what is the level of consumer participation in these programmes?
4. What other Pacific or general consumer development programmes are you aware of?
5. What are some of the consumer-specific roles within your organization(s)?
6. What are the benefits of Pacific consumer leadership? What are the challenges?7. What are the gaps
or barriers to developing Pacific consumer leadership?
8. Do you think there is a need for a Pacific consumer leadership framework?
9. If yes, what are the key success factors of such a framework? What types of support and resources
would be needed for the framework to succeed? How can we convince others to support this
framework?
10.Once developed, at what level should this framework be targeted at? (i.e. beginner level, middle or
advanced? Or all of the above?)
11. Additional comments?

Pacific Consumer Leadership Framework
CONSENT FORM
For Focus Groups & Interviews Consent*
I agree to participate in this session/project and my opinions being
used in the final report. I understand that my name, the names
of family members, employee(s)/employer(s) or clients that may
be mentioned during the session will not be used in the report. In
addition, any recordings or notes taken during the session will be
stored securely and accessed only by the researchers on this project
and destroyed 5 years after completion of the report. The purpose of
this project has been fully explained to me, and I understand that I
am under no obligation to participate in this session and can leave at
any time.
Signature:
Date:
Name:
Organisation:
Role:
Address:
Phone:
Email:
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Appendix 4: NHS Leadership Qualities Framework (UK) [68]
In 2001 the National Health Services (NHS) in the UK, via its Leadership Centre, developed a Leadership
Qualities Framework (LQF) following extensive consultation with key stakeholders over a two-year
period. This framework was produced as a resource for supporting the development of directors and
senior managers within the health sector in the UK.
The key elements for the development of this framework are summarized below:
• Consultation with over 200 key stakeholders including patients
• Working alongside a panel of expert leaders
• The establishment of a diversity reference group with diversity experts both within and outside the
sector
• Analysis of existing competency models and bench-mark data
The initial draft Framework was then trialled with a group of chief executives and directors called
the design group. Additional interviews were conducted post-first directors called the design group.
Additional interviews were conducted post-first draft feedback with other key stakeholders and were
incorporated with analysis of User Perspectives data to produce the final framework. The resulting
Framework, the NHS LQF, contains fifteen qualities encompassing a range of personal, cognitive, and
social qualities. These qualities are couched within three key domains including Personal Qualities,
Setting Direction and Delivering the Service, which are illustrated in the figure below.
[68] Source: www.nhs.gov.uk
Figure 16: NHS Leadership Qualities Framework
Seizing
the future
Intellectual
flexibility
Leading change
through people
Holding to
account
Broad
Scanning
Setting
Direction
Personal Qualities
Self belief
Self awareness
Self management
Drive for improvement
Personal integrity
Delivering the
service
Political
astuteness
Empowering
others
Drive for results
Collaborative
working
Effective
and strategic
influencing

As illustrated above, Personal Qualities forms the core of the NHS LQF and refers to the notion that
leaders need to draw deeply upon their personal qualities to see them through the demands of the job.
This cluster is underpinned by the following characteristics such as:
• Self belief
• Self awareness
• Self management
• Drive for improvement
• Personal integrity
The domains described as Setting Direction and Delivering the Service flank the core.
Setting Direction describes outstanding leaders who are able to set a future vision by drawing on
their political awareness of the health and social care context. Qualities such as seizing the future,
intellectual flexibility, broad scanning, political astuteness and drive for results underpin this domain.
The Framework is completed by the notion of Delivering the Service whereby high performing leaders
provide the leadership across the organization as well as the wider health and social care sector to make
things happen i.e. deliver the service. According to the developers of this Framework the best leaders
who display qualities contained within this domain including the ability to lead change through people,
being accountable, empowering others, being effective and influential at strategic level as well as being
able to work collaboratively help shape national policy.
How is this Framework implemented?
The NHS LQF package includes a Practice Guide containing case studies and various scenarios to assist
providers with identifying their specific needs, as well as a report with full description of the Framework
and Leadership Quality cards all of which are easily downloadable from the NHS website. In addition,
there are online interactive components associated with the Framework which are linked to the
NHS website. The website also features a feedback section which enables the capacity for ongoing
evaluation and reviewing of the Framework. While the use of accredited facilitators to provide NHS
LQF training workshops to health providers is encouraged, the comprehensive, self-explanatory nature
and accessibility of the NHS LQF tools allows organizations to adapt and implement the Framework
themselves to suit their needs.
Who is this Framework targeted at?
The NHS LQF is targeted primarily at senior executives and/or management who work within the health
sector in the UK. It is designed to provide a standard practice of leadership development within the
sector.
Issues with the NHS leadership qualities framework
Word & Gosling (nd) question the individual focus of the NHS framework stating that associating
leadership with certain personal characteristics are short-sighted, adding that leadership is more
relational than individual, shifting, migrating or infecting several of many people at once. The basis for
their arguments arise from two major issues; the first is methodological, whereby the majority of those
consulted for the development of the NHS framework were CEO’s and Directors which begs the question
as to whether the data can be generalized to leaders at all levels. Secondly, on an epistemological
level, they express concerns with the NHS l levels. Secondly, on an epistemological level, they express
concerns with the NHS Frameworks’ exclusive focus on personal qualities such as self-belief, -awareness,
-management, -improvement, and personal integrity. Furthermore they argue that leadership is part
of ongoing social networks and institutional structures within which individual identities, qualities and
behaviours form part of an ongoing process. In this context they summarise leadership or leaders as:
Leader as Causal Agent
• Leadership is a concrete thing that can be independently possessed;
• Successful leadership diffuses top down from a central source;
• An analysis of the origin of leadership explains peoples behaviour;
• Leaders (sic) is ostensibly defined by whoever is in authority.
Constitutive Leadership
• Leadership is a consequence of collective action;
• Leadership, if successful, also results from the bottom-up actions of others;
• Leadership is composed here and now through negotiation and debate; and
• The nature of leadership is negotiable, a practical and revisable matter of performance
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The Framework
· Advocate to key stakeholders that the Framework should guide key strategic and policy documents
and that further planning, funding, contracting and delivery of mental health and addictions services
to Pacific peop4es is undertaken in accordance with this Framework
· Advocate that Pacific consumer workforce development is prioritised and explicitly stated in key
workforce development plans and documents
· Advocate that Pacific leadership initiatives and Pacific consumer workforce development, as guided
by the Framework and other key policy documents, are aligned and consistent regionally and at
national level
· Support a follow-up phase and further development of the Framework. This phase could involve the
development of key indicators and outcome measures
Workforce
· Advocate that scholarships or places in current Mental health and Addiction leadership training
programmes are created for emerging Pacific consumer leaders
· Advocate that emerging Pacific consumer leaders who participate in such programmes receive
appropriate supervision and mentorship
· Encourage the development of a specific Pacific training package to embed Pacific peer support
philosophy within the workforce
· Support the training and employment of specific Pacific consumer auditors to maximize service
improvements in Pacific responsiveness
· Work with workforce champions to develop a module on Pacific consumer leadership to be
included in existing and future Pacific and non-Pacific leadership training courses within the sector
Management
· |Encourage management structures to promote a strong Pacific consumer leadership voice at
management tables
· Consult with current Pacific consumer leaders to explore a good fit for Pacific consumer leadership
representation within current organization and management structures. Note: resources may be
limited so other consumer leadership mechanisms should be explored
Research
· Encourage stakeholder to support by-Pacific-consumer-for-Pacific research initiatives.
· Encourage evaluation of key initiatives and programmes and their impact on Pacific peoples,
including current mental health and stigma reduction and awareness - raising strategies
Fono
Appendix 5: Overview of Recommendations
· Encourage opportunities to have more Fono to promote and profile the consumer leadership voice,
this includes supporting the Northern Region Pacific Consumer and Family forum to take a proactive
lead to create and develop these opportunities
· That the Northern Region Pacific Consumer and Family forum has a permanent place on the Moana
Pasifika

Northland DHB Support Agency Ltd
Level 2, 650 Great South Road, Penrose,
PO Box 112147, Penrose, Auckland, New Zealand
Telephone 64-9-589 3940, Facsimile 64-9-589 3901