Building Partnerships in Rural Mental Health Workforce Development
Phoenix, AZ, March 4 - 5
Sylvia Caras, PhD

This meeting has gathered 70 people, two consumer/survivors (Shela Silverman, CONTAC is the other) at a conference center on a golf course in Mesa, Arizona, about 30 minutes from the airport. In addition to those attending, there are many guests who seem to be mostly retirement age, cheerful, and energetic, wearing traditional golf T shirts, sweaters, spikes, and shorts. There are 17 speaker bios in the program, none consumers. There is ethnic diversity. The first sessions have been all about the great unmet needs, the lack of an adequate workforce. It’s all about professionalizing services and systems. Implicit is also medicalizing. There seems to be no interest at all in prevention, in reducing need, in peer support, in community support. It seems to me if the mental health system really did a good job it would put itself out of business. There’s talk of suffering, illness, disease, stigma - the whole system agenda.

In the 2004 Report to the Secretary, the National Advisory Committee on Rural Health and Human Services indicated "Rural communities would benefit greatly from integrating behavioral health and primary care in rural settings."

PIE model for actions: proximate, immediate, enthusiastic

As I’m listening to this energy around treating more and more, meeting more and more need, educating more and more workers, I am aware that most current mental health programs exile people with psychiatric disabilities into an exclusive mental health ghetto , segregated from other members of their community. I want to see more integration, more finding a valued place in community. I’m also understanding a simple difference - providers and families and the system have a need to impose external control - assisting with lockups and meds. I believe consumers and survivors need to move beyond diagnostic labels to self-management, self-direction, autonomy. Just like everyone else.

The Annapolis Coalition will be developing a strategic plan - comments after March 15 at They are proud that they have included consumers and families - NAMI, DBSA, and CHADD. I suggested they come to Alternatives to present their ideas and gather input but I met with reluctance - "aren’t they all anti-psychiatry?"

Cultural Competence Panel

African-American: Segregation, discrimination, poverty, unemployment, overrepresentation in homeless and incarceration, poor education and prior experiences in the mental health system has contributed to fear, mistrust, shame and reluctance to seek professional mental health care.

Latinos: Between 1990 and 2000, 58% population increase in US, 43% in California.

Culture requires an illness model, the word patient (not client or consumer); culture requires inclusion of extended family, hence concept of confidentiality loses the family, is wasteful

Disconnection of disciplines is a barrier.

Asian-American, Pacific Islander

Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups.

Cultural identity - ethnicity, race, national origin/indigenous culture, rural/urban, migration/acculturation/biculturality, language(s), age, gender, religious/spiritual aspects, sexual orientation socioeconomic status, political orientation, disabilities, subgroups (30 Asian, 20 Pacific Island; 54 Vietnamese ethnic), other

Thomas: "four core factors that underlie an assessment of the cultural competency of mental health providers: 1) the ability to tune into psycho-social, medical and spiritual needs: 2) the accessibility of services and the willingness to negotiate on priorities for care: 3) efforts to reach out to racially diverse communities; and 4) the willingness to listen to and respect people in recovery from various cultures."

Native American

Public education is the only American culture, targets the masses. All cultures strive to survive. In contrast to US, in cultures that value the collective, community is the culture, individual rights don’t exist; only individual privileges do.


1. a capacity to accept the world view of people from a different culture

2. ability to accept others sense of spirituality and/or religious beliefs

3. ability to accept and understand implications of the primacy of collective vs individual values

4. understanding of the system for the ascription of truth value (oral vs written traditions)

5. ability and willingness to seek out and learn from informal literature, legends, stories, ceremonies and other cultural systems of information transmission

Large and small groups chose themes and topics and developed ideas and 35 people stayed for the wrap up.