UNDERSTANDING CLIENT
CULTURE & JOURNEYS
ORANGE COUNTY HEALTH CARE AGENCY(OC HCA)
BEHAVIORAL HEALTH SERVICES (BHS)
CENTER OF EXCELLENCE
MINH-HA PHAM, PSY.D.
&
CO-PRESENTERS WITH LIVED EXPERIENCE
Presentation Objectives
 1. Client culture, world views, self concept, and relationship
dynamics within their cultural and family systems
 2. The cultural responsive considerations in working with
behavioral health clients and their families
 3. The personal challenges faced through interaction with
the health care systems and/or substance use issues, and as
individuals and care giver/family member
 4. Resilience and recovery journey
Definitions of Culture
 “Culture” refers to the shared attributes of a group of
people.
 People can share a culture, regardless of their race or
ethnicity.
◊ Race: “socio-biological category” associated with visible physical
characteristics such as hair, skin tone
◊ Ethnicity: heritage of a particular group
More on Culture
“Culture” is broadly
defined as a
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Common heritage
Learned set of beliefs
Norms and values
Shared attributes
(U. S. Department of Health and
Human Services, 2001)
Cultural Traits:
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Traditions
Language
Ethnicity
Geography
Foods
Values
History
Experiences
Spiritual beliefs
Identity
Recognizing Diversity &
Embracing Uniqueness
It is essential to recognize diversity
◊ Diversity is expressed through both groups and individuals
◊ Diversity exists not only amongst, but within various populations (i.e.
seeing both the “forest” and the “tree” metaphor)
Understanding and respect:
◊ Accepting that each individual is unique
◊ Recognizing our individual and collective differences
◊ Exploration of differences with a safe, positive, and nurturing
approach
◊ Understanding each other’s uniqueness and moving beyond simple
tolerance
Definition of Client Culture
Client culture shares some common attributes in that the
life conditions or disability of a client, the attitudes and
practices of the health care system, and ethnic/cultural
contexts in many ways affect and mold the values, beliefs
and lifestyles of the client, as well as his/her family system.
Landmark & Movement
 A landmark book by Judi Chamberlain (1978) On Our Own: PatientControlled Alternatives to the Mental Health System alerted care
providers across the country about the stigma and discrimination
against mental illness and mental health consumers.
 The Client/Consumer/Survivor Movement: A Civil Rights Paradigm
 The Disabilities Movement: Independent Living Philosophy
 Recovery Philosophy: Empowerment and Self-Determined
Factors Defining Client Culture
Important factors shaping
client culture:
◊ Stigma
◊ Poverty
◊ Labeling (“patient,
client, consumer,
survivor”)
◊ Consumer Movement
◊ Recovery Philosophy
◊ Employment as a
behavioral health
professional
The Negative Impacts of Stigma
 Fear of discrimination is the key barrier that keeps many people
from revealing symptoms and seeking help, services and treatment.
 Stigma does not only reside with having mental health issues but also
with substance use. Both are not mutually exclusive, and both are
heavily judged by society, communities, cultures, families and
workplace.
 Stigma leads to low self-esteem, low self-efficacy, a sense of being
misunderstood, hopelessness.
 Stigma also deters people from socializing or working with, renting to,
or employing behavioral health clients.
Changing Stigma
 Contact with people who have behavioral health issues
tends to decrease stigma
 Understanding the lived experience of individuals with
behavioral health and /or substance abuse issues weakens
people's tendency to link these conditions to violence
Key Facts About Recovery
 People with behavioral health issues can and often do recover
◊ with the support of their peers, family, friends and communities
◊ by working with mental health and/or substance abuse
professionals for proper diagnosis, treatment and medication
 People with mental health and/or substance abuse issues can and do
make important contributions to their family and community systems
and to the behavioral health professions
 Recovery is culturally based and influenced. Values, traditions, and
beliefs determine a person's journey and unique pathway to recovery.
Services should be culturally grounded, personalized and responsive.
From “Client” to Colleague
 Along with housing, employment has consistently ranked as
one of the highest priorities for clients of the behavioral
health system (as well as for people with other disabilities).
 The inclusion of people with the lived experience of mental
health and substance abuse issues into behavioral health
professions is transforming both client culture and the
health care systems.
 This stance also promotes equity in health services, social
justice and advocacy for clients, family members and care
providers.
Culturally Responsive Practice
 From humility and a culturally responsive perspective, health
care systems, agencies and professional providers of services
to clients/consumers should utilize a set of values, skills,
attitudes and policies in working effectively together in crosscultural situations.
 This should include a recognition of and sensitivity to client
culture, as well as to other cultural variables.
Culturally Responsive Health Care Providers
 In order to become effective, provider’s awareness of his/her
own cultural values and biases is the pre-requisite for being
able to accept and embrace similarities and differences of
client’s worldviews.
 A holistic understanding of a client’s experiences, life change
events, spirituality and worldview, cultural and family systems
leads to a more comprehensive understanding of a client’s
development, emotional, functional and cognitive processes
and behaviors.
Effective Health Care Delivery
With a best-practices approach, Health Care Providers:
 Work to understand a person’s perspective on their own
behavioral health and/or substance abuse issues
 Incorporate a strength-based, recovery-oriented approach to
create and maintain a cultural responsive, supportive,
collaborative, spiritual integrative, empowering and engaging
therapeutic relationship
Effective Delivery As A Care Provider
 Show respect and genuine understanding in the form of active
listening:
◊ Take complaints seriously
◊ Evaluate and re-evaluate if necessary
◊ Attend to thorough follow-ups
◊ Collaborate
◊ Be patient and communicate effectively
 Coordinate with other professional providers to deliver and link
necessary care, from housing to community-based supports, in a
timely manner
Effective Delivery
 Be self-aware with the ability to acknowledge one’s own
cultural orientations and limitations
 Practice humility without having to be an expert and learn from
your clients (i.e. asking what has been working and healing in
the clients’ context, culture and community)
 Advocate with your clients
References
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Aguilar-Gaxiola, SA, Elliott, K, Deeb-Sossa, N, King, RT, Magana, CG, Miller, E, Sala, M, Sribney, WM, Breslau, J
(2008). Engaging the underserved: Personal accounts of communities on mental health needs for prevention
and early intervention strategies.Sacramento: UC Davis Health System.
Chamberlin, Judi (1978). On Our Own: Patient Controlled Alternatives to the Mental Health System. Mcgraw-Hill.
Corrigan, P.W. (2005). On the stigma of mental illness: Practical strategies for research and social change. Washington, D.C.:
APA.
Krzyzanowski, R. (2011). Understanding Client Culture: An Experiential Workshop. Retrieved on June 15,
2012 from
http://workingwelltogether.org/dnn/LinkClick.aspx?fileticket=7oqU1DhNOCM%3D&tabid=117&mid=529
Pescosolido, B.A., Jensen, P.S., Martin, J.K., Perry, B.L., Olafsdottir, S., & Fettes, D. (2008). Public knowledge and
assessment of child mental health problems: Findings from the National Stigma Study—Children. Journal of the American
Academy of Child & Adolescent Psychiatry, 47, 339–349.
SAMHSA News (2012). Study finds one-in-five American adults with mental illness, Winter issue, 20, 1, 8.
Tervalon, M., Murray-Garcia, J. (1998). Journal of Health Care for the Poor and Underserved, 9, 2, 117-125.
U.S. Department of Health and Human Services (2006). Developing cultural competence in disaster mental health
programs. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration. Center for Mental Health Services.
U.S. Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity- A
supplemental to mental health: A report of the Surgeon General. Rockville, MD: Department of Health and
Human Services, Substance Abuse and Mental Health Services Administration. Center for Mental Health
Services.
Veccio, V. (2012). SAMHSA’s Working Definition of Recovery Update. Retrieved on June 25, 2012 from
http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/
Experiential Journeys &
Perspectives
 John, Team Lead, OC Wellness Center
 Minni Lucas, Outpatient Recovery Services Coordinator,
Mental Health Association-OC
 Nicole Lehman, Director, Recovery Education Institute, Pacific
Clinics
 Greg Wright, Family Member, MHSA-OAC, Mental Health
Board, Art for Wellness & OC Stigma Elimination Task Force
"If you focus on the competence of people with
mental illness, that tends to lead to greater tolerance.”
Pescosolido
“In the attitude of silence, the soul
finds the path in a clearer light”
-- Mahatma Gandhi
“ When I dare to use my strength…
Then it becomes less and less important
whether I am afraid.”
Andre Lorde
“We need to give each other the space to
grow, to be ourselves, to exercise our
diversity. We need to give one another space
so that we may both give and receive such
beautiful things as ideas, openness, dignity,
joy, healing and inclusion.”
--Max de Pree
Until
Until I eliminate the stigma within me, the changes I wish to
see in the world will never happen. No matter where that
voice came from, I must silence that voice or continue to be
part of the problem.
Melody Marler
Patient Rights Advocate
OC HCA/BHS
“It is not what we read but what we
remember that makes us learned;
and not what we profess but what
we practice that gives us integrity.”
--Francis Bacon
Each of us shines in a different way, but this
doesn't make our light less bright.
Albert Einstein
“Dreams are renewable. No matter
what our age or condition, there are
still untapped possibilities within us
and new beauty waiting to be
born.”
--Dr. Dale Turner
Go On and Be
I see a beautiful you,
Thoughtful and warm
I see sunshine beyond the golden hair,
A yearning for freedom
Like those waves at sea
I see an unlimited sky
In your endless blue eyes beckon to
Go on, love on and be precious wonderful you…
Minh-Ha Pham, Psy.D.
“Darkness cannot drive out darkness;
only light can do that.”
Accept finite disappointment, but we
must never lose infinite hope.”
--Martin Luther King, Jr.
Hope
For every heart that has known hurt,
Hope casts a light
That shines through darkness
To find a path
To a healing place.
Hope is the golden thread
That gathers courage and strength.
It is where a soul can be restored through forgiveness.
Hope brings the magic of Spring;
Renewal through the wonder of transformation,
Awakening dormant hearts
With real meaning, at last
Minh-Ha Pham, Psy.D.
“To accomplish great things, we
must not only act, but also dream;
not only plan, but also believe.”
--Anatole France