Building the Raft While Drowning: Searching for Mental Health Help & Hope in Rural America
Born out of a personal quest to understand and navigate the complicated system of behavioral health, podcast host and ND's Public Policy Ambassador for the American Foundation for Suicide Prevention, Sarah Dixon-Hackey, offers listeners an opportunity to hear firsthand stories of providers and advocates working in the trenches of the mental health crisis. Guests are given a platform to share the ways they are making an impact, community resources for navigating behavioral health, and a better understanding of the ways in which public policy shapes our current system.
Building the Raft While Drowning: Searching for Mental Health Help & Hope in Rural America
Mental Health Across Cultures: A Conversation with Aline Muhimpundu, LAC
Episode Description:
In this episode, I sit down with Aline Muhimpundu, a licensed addiction counselor, to explore what it truly means to provide culturally competent mental health care for individuals from diverse backgrounds—especially refugees and New Americans.
Aline shares thoughtful insights on how mental health and substance use are viewed in different cultures, and how those perspectives can shape the way people seek help—or don’t. We talk about the importance of cultural humility in counseling, and Aline offers practical tips for recognizing signs and symptoms of mental health or substance use challenges in people who may express distress in unfamiliar or culturally specific ways.
Whether you're a mental health professional, someone working with resettled communities, or simply curious about how culture influences care, this conversation is a must-listen.
If you or someone you know is struggling or in crisis, call or text 988. For additional mental health resources visit any of the following links:
Welcome to building the raft while drowning. a place to talk about mental and behavioral health advocacy in rural America. In this episode, I'm joined by Aline Muhumpundu, a licensed addiction counselor and cultural community advocate. Drawing on her roots in nonprofit work and behavioral health, Aline champions spaces where individuals from all walks of life can receive support and care that aligns with their needs and values. During our time together, Aline and I talk about the nuances of mental health in different cultures, what it means to provide culturally competent health care, and some of the signs and symptoms that might go unnoticed in the beginning stages of a mental health or substance use crises. The content discussed in this podcast includes topics related to substance use and mental health. This information is intended for general informational purposes only and should not be considered a substitute for professional advice, diagnosis, or treatment. If you are experiencing emotional distress or mental health challenges, you are strongly encouraged to consult with a qualified healthcare provider or mental health professional. Alrighty, my friends. Well, we are here today with Aline. And Aline is one of those rare gems in our community that I really kind of got to know through a friend of mine. I kind of joke that this friend is the six degrees of kind of separation from everyone. She just kind of knows everyone. But Aline is a fantastic resource in the behavioral health spaces. I like to kind of let people introduce themselves. So I don't know, Aline, maybe you want to talk a little bit about what you're doing right now in the community professionally?
SPEAKER_01:Yes. Thank you very, very much, Sarah, for inviting me on this platform today. Like you said, my name is Aline Mohimpondo is my last name. I moved to the Fargo-Moorhead area, I think, 2012. And I have been living here since then with my husband and my three children. For now, I do work as an addiction counselor. I have a degree in counseling, and at the moment, I'm a licensed addiction counselor. but I also do some mental health work in the refugee and immigrant communities around here for the most part. So I like to be there and see how I can help, especially with my background, my cultural background, myself being an immigrant. So this is what I do for now.
SPEAKER_00:Well, and if I can just kind of dive into that a little bit. So where are you originally from or what's your home country? I'm
SPEAKER_01:originally from Burundi. Burundi is a small African country, French-speaking African country on the east side. And that's where I was born and I grew up there. And yeah, like I said, came here 12 years ago from there.
SPEAKER_00:Well, and it sounds like you had, because of your experiences, just an ability to kind of really just see lots of different perspectives. So it gave you, like you said, that kind of motivation almost or insight into how you could really be of help. And I think it's so fascinating because you and I have had conversations before about this idea of cultural competency in behavioral health services. I'd really love to just kind of move on into that area. you know, I think topic for just a little bit here because, you know, it's something that I wasn't as aware of, even though I can, you know, I identify as a person of color. I don't think because I was raised in a white environment and with a white family, And I was really truly understanding of it until I kind of embraced more of not only my own experience, but also looking at what other people are experiencing. So can you tell me a little bit, because I know we've worked with you or I've worked with you in some other projects, but what do we mean when we say culturally competent? What does that mean exactly, especially when we look at it in behavioral health?
SPEAKER_01:It's really... how this topic can be broad and yet can be, how can I say, sharp. I don't know if I want to define sharp, but something that's very, very delicate and very precious, I want to say. Culture and mental health, very connected. It's connected when we talk about mental health. wellness it has to have culture in it so when we talk about these immigrant refugee families we know that they come from all different cultures different backgrounds different environments they come with you know different values different beliefs uh it's uh it's very different from what we see in the like the societies So it's like when you try to help someone, you have to maybe understand them first, literally and figuratively. Understand them like language-wise, communication-wise, and also understand what is behind what they are sharing and communicating when it comes to culture and their needs. challenges, strength. So it will be very hard if you do not really know anything about that other culture to be able to help someone from a different background. We know how cultural backgrounds like help with expressing emotions, solving problems, actually define norms of societies. So many of the modalities, if you will, in counseling focus on strength, individual strength, protective factors. So understanding those will really help kind of actually define appropriate interventions. for the appropriate needs, individual needs for that individual or that person. So it's like the outcomes are going to be defined by the interventions the diagnosis and if you know making a good proper diagnosis comes from like understanding the person and understanding the culture background to some extent it's really very difficult to be fully fully cultural competent but it's like the best you can to do to put yourself in their shoes to understand them and to actually treat them based on what works for them Well, yeah,
SPEAKER_00:absolutely. I mean, I'm just curious too. So just to kind of give a bit of a glossary, if you will, or a definition, because I know we use a lot of terms in both the public health and behavioral health spaces, like protective factors, but to someone who maybe doesn't always use that language, I mean, what would you define as a protective factor? Like what's an example? An
SPEAKER_01:example would be You know how many cultural backgrounds, like many other societies are more of collectivistic compared to this kind of individualism that we see in the Western civilization. So, for example, being together in a community, it's a huge strength. because people rely on each other. So that's a very big protective factor right there, for example. That's a strength that, you know, when people surround others, when they go through things like loss, they live together, when they lift each other up, even when they don't have much, but share what they have, it's a big strength to have. to build upon when you are treating like a family that comes from that environment.
SPEAKER_00:Well, and I, you know, never heard it explained, I think quite as well as you just did right now, which is this idea of, we have a lot of, of new Americans in our community that come from collectivist societies where, you know, you are, you are not one alone. You are one of many. And I think it's this idea of everybody being connected and tied together. Whereas, like you said, in the US, whether or not we realize that we are much more of an individualist, right? We look at, you know, how can we as individuals climb the corporate ladder? How can we find success individually? And so when you talk about like this idea of collectivists, I mean, I think it's interesting because there's a lot of emphasis right now on reducing this concept of isolation, right? And even in, you know, Kind of the mainstream of what mental health, we've talked a lot about this idea of loneliness. This has now become a secondary epidemic to, if anything, the pandemic to some extent. I mean, and looking at that for some of the new American families, I mean, what do you think, how did that affect you? them, do you think, especially if you're looking at the fact that they come from these collectivist, maybe kind of community-based environments? I mean, what was the impact of that isolation period for the last few years?
SPEAKER_01:Oh, it has definitely had a big impact in many, actually many communities. If I give you an example of how the, I'm not going to go into details, but how the process of immigrating here happened for many people, like for refugees, for example. Those are people who are forced to leave their homes, their families, their belongings, their culture. They don't necessarily choose that. And that's already something that's going to be like a big, like a negative impact. And through that journey, they go through so many hardships. which you may know. And they, you know, many of them live in a host country or like, you know, where they have like either refugee camps or other settings. And that's not their country either. And they don't have everybody of their own. And then they get to the third country, let's say US in this situation. And by the time they go from home to here, they have lost so many connections. Family members are staying behind. The people may not be eligible to join them even for a long time or even ever. So that already is something that's going to negatively impact their sense of that community and being with other people. And then they get here Well, you say you have to go to work and then come home. There's probably not many people from your community or many people that you can identify with. Social connections are not that strong yet, but yet you have to keep going because life is life. It doesn't stop, especially here when you have to pay your bills and some other people still have to support you. Some members, they left behind. So it kind of affects many people in different ways, negatively most of the time because of this lack of that connective tissue that was there before. And also on top of that, knowing that it may not happen again. It takes a lot of resiliency for many people to really build new connections. And they do the best they can. They do a great job with, you know, connecting with people who do not look like them, people who do not share the same culture, background values, morals. But then, you know, they tell you you have to integrate. But it's hard, especially for people who are not, young, it's really very difficult. You don't speak the same language with many people. So all those are layers that add on to that isolation and takes away that kind of sense of well-being that we are talking about.
SPEAKER_00:What is it about mental health? Is there stigma associated with just that term sometimes when we use that with individuals from other cultures?
SPEAKER_01:Yes. Yes, I remember I was somewhere in a meeting and someone who was sitting next to me, he's also an immigrant, he just shared this example about from where we come from, you are either sane or crazy. There is no spectrum. There is no in-between. It's like you are either okay or not okay. And not okay means maybe you are on the streets throwing stones um running around naked or chasing people with uh you know sticks so that is what they or we define you know like we we we call mental health so this idea of someone who's anxious or someone who is depressed i like to also give that example that we don't really have a term for depression And if I try to translate anxious or somebody who shows as anxious in my culture, I would just say, this person has fear. So fear of what? Fear, no, just fear. So anxious. Yeah, so there is a lack of education around some of those terms saying that depression is a mental health. The anxious is part of mental health. Trauma is part of mental health. So that also makes it that it becomes a stigma when we are approaching those. I mean, here, especially here, It's when a provider mentioned that you may have a mental health problem, it can be hard for people to really receive that because of the stigma and or because they simply do not make this connection to like what is mental health back home and what I am experiencing now.
SPEAKER_00:right
SPEAKER_01:so it's yeah so
SPEAKER_00:when it comes to this idea then does that create a problem or a challenge when working with trying to get patients the you know support or assistance i mean how do you even have a conversation then if that term really kind of shuts down the discussion like what are some ways that you found that you've had to work around that
SPEAKER_01:um so that's like it um that's really why it is very important for somebody who's a provider to understand that culture because then they know how to communicate better they know how to explain things better so challenges that we come across are that people have difficulties accepting that they have a mental health condition people have difficulties understanding that it's a it's a disease that can be treated in a medical setting sometimes. People have a hard time with understanding why a peer could help. So yes, there are so many challenges when it comes to seeking help because also this person, this client may feel that the doctor does not really understand what it is the doctor is trying to explain the symptoms from the book but this person is like no this happened because my neighbor doesn't like me they put something in my food it's nothing to do with me so it's a whole bunch of different concepts and like different situations that could show like why there is this barrier when it comes to seeking help in the mental health area for these populations,
SPEAKER_00:yeah. Okay, wow. I mean, I just feel like that opens up a whole other set of challenges in trying to, A, just have the discussion, let alone trying to then move into how do we help and support and treat if needed. I mean, is that... Are there challenges then when you look at, you know, I've had a conversation with someone else that sometimes, you know, just even people that have been raised in the U.S. that medication still has some stigma to it. But I mean, does that also carry stigma in other cultures as well? Or I mean, what's the dynamic there? You
SPEAKER_01:mean like medications for mental health?
SPEAKER_00:Yeah,
SPEAKER_01:yeah.
SPEAKER_00:So
SPEAKER_01:psychotropics. Yeah, it's... like I said you are either sane or crazy and when you are crazy when they treat you they give you that shot they call it a shot that is going to just turn you into something different so people have seen some situations where because back home we do not have many options of psychotropic medications either So like we don't have, you know, like many mental health services. We do not have many psychiatric hospitals. So it's really not, it's easy for them to miss the opportunity to see different alternatives and medications with the whole stigma and the myth So many made behind psychotropic medications that would prevent people from taking them. Also, like you mentioned, something about giving examples. So like an example of a patient who would take, I mean, who would go to the doctor, they would give them some medications, but is in the other meds. it's going to take time to work. But this person is expecting the whole mood to change right away, the whole situation. But when they take the medications one, two, three times and nothing has changed yet, they just, I know this one person who will be like, no, if I drink, the whole situation changes right away. My mood will change. My problems will go away. These pills are not doing anything. So they would prefer to throw the pills away and have a drink or I don't know how much. So that's another problem that is there. People do not understand that it would take time to work.
SPEAKER_00:Yeah. There's what? Mismatched expectations. I mean, so like hearing you say that, do you feel like, I mean, I know from what I've learned and I know obviously you do too, that, you know, mental health and substance use are so incredibly intertwined, right? It's hard to say, you know, which started first or what influenced the other in people sometimes. But I mean, do you find that... Is there a certain level or a higher level of substance use in individuals that refuse to use treatment or refuse to be treated? I mean, do they self-medicate sometimes or what does that look like? I
SPEAKER_01:actually have a fear that this is what is happening, especially in our communities here, because people who do not seek help, who do not seek treatment, because some of the things we said earlier, either stigma or maybe not even understanding what is going on with them. So it's really easy to reach to that drug or alcohol because especially many refugee immigrant populations come from cultures that have alcohol as part of their social life. It's socially acceptable and it's accepted. It's part of cultural functions, cultural everything. So everybody drinks, including kids in many societies. I mean, it is here too, but we at least know here that it's regulated and it's not okay, so to speak. But back home, difference is it's okay for everybody to have a little bit of that. So when someone has been maybe using, drinking, using drugs before, it's going to say, like you say, it's going to be hard for them to know if they suffer from depression, anxiety, which came first. Because they may have even started to drink because it made them feel different. Different when they experience depression and or anxiety, they did not know, but they knew this kind of medication would help. But we also know that, for example, alcohol is a depressant. It's going to even make it worse. So then it's going to continue. And if they give them pills, it's not going to work because it's going to be like, uh-uh, I know what works better. So I have a fear that it's actually more than what we know in these communities. And also on top of all that, all the traumatic experiences, negative experiences that people encounter or encountered on their journey, and the whole isolation and other things, challenges that happen here, all those things can cause people to you know, their brain will remember that something helps or something helps alleviate or, you know, give them a relief. But what they don't really maybe know or remember is that if they continue to self-medicate, it's going to make everything worse. So, yeah.
SPEAKER_00:What are, you know, what are any signs and or symptoms that you would provide to the general community? You know, In terms of your expertise, what are things that people should be on the lookout for if they're concerned or that should maybe look at as concerns for either mental health or addiction? People who
SPEAKER_01:isolate, people who do not show up when social settings and people who are not interacting with other people socially. It's a big red flag. for people in our communities. So that is something that would probably be noticed by the fellow community members. I don't know if you are asking also from the general population what to look for in our communities. Maybe I did not get the question right.
SPEAKER_00:well I mean I think so if they're concerned about a loved one or a friend I mean are there any signs or symptoms they should look at and definitely I mean I'm glad you said isolation because I think sometimes people they can easily make excuses right oh they're just tired or I you know I've had a hard week at work that kind of stuff but are there other things we should be looking for oh
SPEAKER_01:yeah definitely yeah if there is this kind of Like the excuses, repetitively, especially repetitively, that could be a sign to look for. People who live alone tend to, especially with like how life goes on, like here people go to work, they don't really remember to check on their friends or somebody. It's simple as when you, send a text or a call, somebody doesn't pick up or doesn't return your call two, three times, that maybe could be a red flag. Somebody who's in our community, somebody who's, I wanna say, who's getting involved into maybe more of a substance use, more than, or stat, doing um start using or drinking when they didn't i mean i'm not saying that people don't but i'm like there are ways you can see that there is more um some behaviors also like symptoms that we come with that substance use or mental health uh problems so looking at like different behaviors like somebody's acting differently um People from our communities, they know that the number one priority here is to go to work. If somebody is missing work for no reason, it could be our side. People who live with other people, back home when somebody doesn't get up from their bed and do what they're supposed to do or somebody who doesn't take care of themselves the way they should maybe or the way they used to then back home or people from like our communities they'll be like what's wrong with you what's going on like not in a sense of asking that you're okay but those could be signs of depression people who seem to have a hard time. So learning how to notice and ask from a genuine point of view of really wanting to know if that person is okay. But it also takes both ways because this person, remember the stigma and everything may not open up right away. So it comes back to checking on each other and knowing what's going on with the neighbor, your friend. Just conversation, touching, listening to catch what they mean. Some people may speak in a way that they mean something else, but if you're not actively, genuinely listening, you may not get what they say and they are not going to repeat it because they probably don't have the intention of you understand. Because if you understand, maybe, or they could also have that intention behind, but they cannot openly say it. But they actually maybe are crying for help in a way that if you're not listening, they may not be able to catch. Yeah.
SPEAKER_00:That's incredibly helpful, I think, too, just to have those specific signs because again sometimes we take for granted and i think it's so true like you said life moves at such a pace and sometimes we don't take those few moments to actually ask wait how are you doing right is everything okay or i noticed that something's different um and so you know especially i think i love that you Framed the examples to in some of the context of how it's in some of these cultural communities that especially, you know, work is a priority. So if you're not showing up for work, because, you know, other than being sick, that could be a, like you said, a sign of something else going on. So yeah. I think it's incredibly helpful to have some of these because I get asked that all the time, you know, what should I be on the lookout for? What should I be mindful of? Or people will say, well, I didn't, there were no signs, but sometimes we don't know what to look for. Right.
SPEAKER_02:Yeah. Yeah.
SPEAKER_00:Yeah.
SPEAKER_01:And it's hard and it's, it's hard to see and know all the signs, even in other cultures. Yeah. Like being there for each other. I think that's where everything happens. like starts. But when you are there for each other, there is more to share. There is more to open up about and you are able to catch more than somebody who's there just like once every six months or something. But we also know it's hard with life. Again, it's really difficult. But knowing that you are there and then people know they have someone They can trust someone they can go to. It's really very important when it comes to who they can share their struggles with because there's another cultural component for many of these communities. You do not share your problems with everybody. You do not open up to anybody. It has to be somebody that you trust. We want to make sure that We can be those people people can trust and we can have those people that we can trust.
SPEAKER_00:I think that's so well said and such a great piece of advice that we kind of leave on as a final note here. Again, Aline, what a wonderful way to spend my afternoon having a chat with you. I know you're a busy woman. Every time we've connected, I feel like you're on the way to something or coming from something. So I'm so glad.
SPEAKER_01:No, I appreciate you and you giving me this opportunity to share some of these things. And also, I know you really work hard in this area and you have so many people. You really help reach out to many people and you are doing an incredible incredible job here so I'm really lucky to have you and to get to know you as one of the people that I know are doing this work in the community I really really appreciate what you do
SPEAKER_00:Well, thank you. And again, my friend, I hope we get another chance to talk in the future. There's always more conversations to be had. So thank you so much for joining me today. Again, I hope that we connect in the future. So Aline Mujampundo, wonderful, wonderful advocate and behavioral health professional in our community. Thank you.
