Beyond Cultural Sensitivity

There’s an interesting idea becoming more prominent in the mental health and community services area. Here in multicultural Australia we’re starting to talk about making sure services are culturally appropriate. Some examples I’ve come across are allowing traditional healing ceremonies for a person from an Aboriginal or Torrens Strait Islander heritage who is suffering from severe mental illness. Another is being willing to use the terms and frameworks about mental illness that people from a different culture are more comfortable with.

There’s an interesting tension between the goals of wanting to educate, raise awareness , and reduce stigma about mental illness, and wanting to be sensitive to the beliefs and understandings of different cultures.

From my perspective one of the things that interests me is how narrowly we are currently defining this idea of culture. If a white European turns up in the psych ward convinced he is hearing the voice of God it is explained to him he is psychotic. But according to the expectations of cultural sensitivity, it’s not appropriate to say that to someone from a CALD (culturally and linguistically diverse) background.

From the perspective of someone who’s spent a lot of time rejecting the mainstream culture I was raised in and embracing the values and ethos of various subcultures instead (such as goth), I find it frustrating and offensive that being Caucasian means it is assumed I am of the same culture as the social workers who put together community programs.

Most of our mental health services operate from a set of values that in my opinion are very middle class. I see that as both as strength and a weakness. There are a number of middle class values that are pretty awesome, and there are a lot of people who find these values and this culture the most comfortable and reassuring. But on the other hand, there is a high need for appropriate support for people from marginalised subcultures, as that experience of being marginalised is one of the risk factors for developing a mental illness.

When everyone is dressed in suits and speaking clinical psych lingo, our hippies, punks, goths, stoners, metal heads, bikies, artists, sex workers, emos, nerds, surfies, queers, new agers, and skinheads may not feel comfortable looking for support, and may not be able to find the kind of support they actually want.

I think defining cultural sensitivity more broadly means encouraging diversity of many kinds in our mental health services. I like to see people from CALD backgrounds in services. I also like to see men and women, mainstream and alternative, younger and older. When our services get uptight about appearing ‘professional’, often under the mistaken idea that all people see this as a sign of respect, I am depressed. When we translate fact sheets and information into Italian but not into Plain English for laypeople I feel like we’ve missed the point. And when we go to a lot of effort to create environments in which our funders would feel comfortable but not our highest need people with mental illnesses I’m deeply frustrated.

The training around social and community work has a language that mostly leaves me cold. I drive through small towns with little community centres bravely trying to offer social cohesion and connection in a format that is perceived to be so profoundly uncool that only the most desperate or dis-empowered will seek help there. On the most basic level, having almost no services available after hours when we know that after hours are the peak need times, that many people with mental illnesses are most stressed and vulnerable at night when they can’t sleep and can’t talk to friends or family is such an obvious clash between the need and the structure of the services.

Another example is of a young person seeking to rebuild their life following an episode of mental illness, and encountering a major culture clash between their needs and the values of the support staff. They loved to DJ which involved late nights, but the staff were trying to help them get up early and have ‘normal’ sleep patterns. Whose recovery is this, anyway?

Mental illness and different from the norm are often confused with each other. It can be difficult at times to get people to see them as separate concepts. One of the things that concerned me back when I started this blog is that I am a fairly alternative person – my way of coping with a stressful talk at an interstate conference is to dye my hair green. I worried that my artistic nature would make me a poor spokesperson for all those people with mental illnesses who are trying to explain – ‘look we’re normal’! Then I thought about all the oddballs like me who also need spokespeople, particularly those who can say ‘I am not normal and I don’t want to be normal, but I do need support to function!’ ‘Normal’ and ‘healthy’ are different concepts. ‘Different’ and ‘mentally ill’ are also different concepts. Some of us crave a link back to wider society and need our ‘normalness’ recognised. Some of us want our uniqueness to be seen as separate from our challenges, because we want help with one but have no intention of being ‘cured’ of the other!

The most frightening experience for me as an alternative person with a mental illness, has been struggling with homelessness and poverty and feeling very keenly that it’s critical I find a way to be perceived as valuable in the eyes of the people who control the resources. I wore no strange clothes to Centrelink appointments, no unusual hair or makeup to see people about housing support. Alternative people do not often run funding bodies, they are corporations with business and professional people in them who are comfortable in a corporate world. These are the people who set the tone for the services, and they feed and house their own.

What bypasses this? Community based support. Things were incredibly rough last year for me, and where I was staying I had a lovely neighbour who regularly gave me food over the back fence. That did a hell of a lot more for me than a visit from a community nurse. Taking in mates between houses, helping people move, gardening bees, hosting catch-up’s, pet sitting, volunteering to help at an art class, these things change people’s lives. Kindness is the greatest gift to anyone in difficulty, and is most spectacularly demonstrated between people who are both struggling. Often the most generous behaviour is between those at the bottom who know hardship and the difference that a gesture of care can make. What you do in your life matters, you don’t need to be well, or working, or saving whales to make a difference. How you choose to treat people, the other stressed out people admitted in hospital with you, your difficult neighbour, the girl at the community centre who completely rubs you up the wrong way – these things count. They make a difference, and you know they do, because each of us has experiences where care mattered, or where kindness was absent and its absence was painful.

So, I like the idea of culturally sensitive services. I especially like it when it dovetails with the idea of client-centred services, where there is recognition that on some level, each family, each friendship group, each religion, each town also has its own culture. Services also have a culture of their own, language, values and traditions. Sometimes there is a good match between these cultures and sometimes there is a painful clash. Good services adapt to the people they are there to support, and they model diversity of cultures within themselves. The best outreach to any group is often from a member of that group, and that means we need to create a culture in our services that welcomes and embraces people from diverse backgrounds in a way that encompasses and goes beyond CALD.

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