Insiders to dominate cultures often think that their behavior, belief system and choices are “common sense.” They can go their whole lives without conscious awareness of their own cultural upbringing. They may not know how their culture influences their sense of right or wrong. When this happens they may perceive the behavior of people from different cultural views as problematic. They may use words such as “difficult” “non-compliant” “disengaged” “secretive” “hostile” “angry” “dysfunctional” “manipulative” “lazy” or the like. This happens with systems and organization too. If you are someone from outside the majority, you may find experience multiple challenges and confusions by what seems like almost willful lack of recognition from insider groups. When this tension is not resolved in healthy ways, it is the root of cultural conflict.

Think back to when you started your job or professional training. There were probably many things you questioned. Some things may have seemed odd or inappropriate. However, if you stayed in your role, you most likely became acculturated. This is part of the reason why people from very different cultural backgrounds can struggle to be employed in or served by organizations. They may have too many cultural differences to find a niche.

• Concept of many key aspects of services are vastly different in cultural groups. This includes definitions and experiences of family, community, decision-making, illness, and mental health.
• Power differentials are embedded in services. Just by being a gatekeeper to services, professionals have power. People with mental illnesses and their families are not very powerful in the system except by avoidance. Intersectionality with other aspects of identify that are not well supported (such as race, sexual orientation, etc.) exponentially increases lack of power.
• A general lack of transparency and coordination in services means professionals have little understanding of the “whole” experience of people in these systems. It is a confusing and difficult process for many, even if they benefit from it.
• Multiple inequities in transportation access, service access, other resources and support can make using services as usual very difficult for some individuals.

Every individual in a system should spend time examining and recognizing their own culture and worldview. They should also learn about the cultures and experiences of others. These are things you should explore. Consider your personal view. Reflect on your organization and system views of these. Learn about the views of other people and other communities:

• Making explicit views about people with mental illnesses and their families. What is it? What causes of behavior? What does recovery mean?
• Recognizing cultural views of family. What are appropriate and expected roles for family? How important is family in recovery?
• Recognizing the history of mental health and related services or systems. Learning about the impact of this on individuals and communities. How does this influence your behavior? How might it influence the behavior of others?

Kamau’s Uncle shows up to Sharon’s office. He wants to know why she has been recommending medication for his nephew. He says the medication makes Kamau like a person who is both living and dead. He says Kamau is never home but wanders that streets. He wants him to get to a healer and not take these medications. Sharon looks in the file. There is no listing of Kamau’s uncle in the file. (There is also no place to list relatives other than parents or siblings on the form.) She says: “I’m sorry, I cannot affirm or deny that I know Kamau. If you think he is getting services here you will have to talk to him.” He says: “I can’t find him.” She says: “I’m sorry, I can’t help you.”

What implications do you see for this as far as person and family-centered practice? How does it affect the interaction today? How does it affect each person’s ability to work with professionals in the future or to receive quality person and family-centered services? What could be done differently from your view that might work better, if anything?