People’s experiences and relationships are mediated by cultural, social and historical contexts. In some cultures, individuality and personhood are not emphasised as much as kinship and family ties. Deference to community leaders—traditional healers, priests, elders and community leaders—regarding personal decision making is a strong tradition in some communities. Other important drivers are maintaining harmony within the family, obligations to engage in acts of charity, facing adversity with acceptance, and the importance of engaging in ritual–spiritual practices. All of these factors will be at play and have an influence on a person’s experience of recovery.
Implications for practice
- Be mindful of the impacts of trauma and distress arising from racism, sexism, colonisation, genocide, torture, sexual and physical assault, poverty and natural disaster as well as the stigma and shame associated with having mental health issues. These impacts frequently last for generations.
- Specific skills are required for working with families, elders, interpreters and cultural advisers and being aware of cultural differences in verbal and non-verbal communication.
Implications for service delivery
- Service environments should make people feel safe. They should support healing and recovery.
- General practitioners are often the first, and sometimes the only, point of contact for some immigrants and refugees, because the stigma and shame they feel about mental illness may prevent them from using specialist mental health services. Recovery-oriented mental health services can support general practitioners in their role.
- Ida (2007) emphasises the importance of integrating primary health, mental health and drug and alcohol services while simultaneously helping people to reclaim their culture and community as part of their recovery.