Cover image of Let's Talk Employment guide
Let’s Talk Employment
A Guide for Family Members of Individuals in Mental Health Recovery


Cultural Issues and Special Populations in Employment


America draws strength from its cultural diversity. The contributions of racial and ethnic minorities have suffused all areas of contemporary life. Diversity has made our Nation a more vibrant and open society, ablaze in ideas, perspectives, and innovations. But the full potential of our diverse, multicultural society cannot be realized until all Americans, including racial and ethnic minorities, gain access to quality health care that meets their needs.


What Questions Should I Ask?

  • What cultural concerns may impact employment?
  • How can the Employment Specialist and the employer help to accommodate cultural needs?


What You Should Know

“Culture is central, not peripheral to recovery,” as cited by the Psychiatric Rehabilitation Association (PRA) in their principles of Multicultural Services. Culture is really central to the understanding of mental health condition and to the overall treatment. (Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. NCBI)

If your family member is a part of a racial, ethnic, religious, sexual, or other minority; it is important that any cultural concerns related to work are expressed to the Employment Specialist and, at times, to the employer. The Employment Specialist can work to keep the doors open to employment for all populations and to recommend supports or accommodations that would help individual job seekers with needs, such as translation of policies, meeting notes, and other materials or interpreters for required meetings.

At times, there may be outright discrimination in hiring, promoting, firing, and layoffs. More often there are more subtle forms of bias or micro aggressions that occur in the workplace. These micro aggressions, such as stopping the conversation when the employee enters the room or leaving someone out of a social situation, can be very hurtful and reinforce feelings of isolation or can hurt their confidence.

The employee who is a minority may have to adapt to the majority culture, which can be very stressful for many people especially those who have been out of the workforce for a while. Families and Employment Specialists can be helpful by being supportive to the individual, but also by rehearsing ways to deal with micro aggressions. Rehearsing verbal responses and body language to use when someone is feeling uncomfortable about lack of acceptance in the employment setting would be especially helpful. For someone who is potentially discriminated on multiple levels (e.g., race, disability, and ethnicity) feeling armed with assertive language can be very helpful.

Two people reading from a piece of paperFamilies can help their family member to identify what supports or accommodations (cultural) might be needed and how to communicate these to the Employment Specialist or the employer. Here are some questions a family member might suggest to be part of the conversation with an employment specialist and their family member:

  • How does one’s cultural values impact our vocational identities?
  • How did your cultural upbringing influence your values about employment?
  • What kind of views does your culture have about disability and unemployment?


The employee (family member) should let the employer know if there are certain holidays or customs that are very important and also how the employee plans to observe them. Some jobs would be unacceptable to a family because of cultural or religious values, so these concerns should be communicated to the Employment Specialist.

The culture of unemployment, which exists for people with mental health conditions, can make the idea of employment very challenging, even frightening. Employment rates, already low, are getting worse for people with mental health conditions (23% employed in 2003 down to 17.8% in 2012) (NAMI). This is in spite of the increased availability of specialized employment services, such as Supported Employment.

Market with sign that reads Carniceria y Tienda Guerrero

In addition to responding to the cultural issues related to employment, families are dealing with the need for cultural competence in the full array of services needed for mental health conditions. Often there are cultural, linguistic, or racial barriers to mental health services, so strategies are needed in these situations.

There are, in a sense, different layers of culture, and though we typically do not think of a business as a “culture,” there are considerations in the local business community that the Employment Specialist would take into account when matching the job seeker with the employer. Each company and each work environment has its own culture. In some cases, there exists racial discrimination.


Other special populations:

Some groups that require special skills, sensitivities, or resources in mental health and employment services include: immigrants, veterans, deaf and hard of hearing, young adults, residents of rural areas, LGBT community (and many others.)



Immigrants play an important role in the overall American workforce. In some cases, whole industries depend on immigrant labor. Some immigrant workers may not have a family support system in the U.S. but often are motivated by employment in order to send money to their families. Members of the immigrant workforce, who also have mental health conditions, may need more coaching, support, and help understanding the norms (from professionals and the natural community).  What can job seekers who are immigrants do to get jobs?

Non-U.S. citizens, who wish to qualify to work in the U.S., can apply under one of many work programs. They may apply for a work visa with permanent residence in the U.S., as well as those who wish to apply for a temporary work visa. It should be noted that the state Vocational Rehabilitation agencies are not able to serve directly or indirectly (through providers) individuals who do not have a valid Social Security card. Therefore, it is important to search out other possibilities that are not bound by such restrictions for needed services. Because of this, it is important to know what the funding sources are for those programs, such as Supported Employment or Clubhouses.

Non-citizen employment a.  

Non-citizen employment b.

Information about green cards

Once the immigrant has verified that he or she can be authorized to work in the U.S., he or she can begin the search for employment (unless the employment is attached to a specific employer for a specific purpose and time frame, such as an agricultural company that hires seasonally). Any restrictions on employment need to be established as well. “The only eligible individuals are either: citizens of the United States, aliens who have been lawfully admitted to permanent residence (popularly known as having a “green card”), or individuals expressly authorized by USCIS (U.S. Citizenship and Immigration Services, Department of Homeland Security) to be employed.” (Harvard Law School, p.2)

Ingraham, N. (2011). Citizen guide: Hiring non-citizens. Bernard Koteen Office of Public Interest Advising. Harvard Law School. Hiring Non-Citizens
U.S. Citizenship and Immigration Services

Employment of non-citizens in the federal government

Immigrant labor force in the U.S.

Outline drawing of children and adults with national flags from around the world filling in the bodies

What can employers do to integrate and support immigrants in the workforce & reduce language barriers?

Although this is a Canadian Human Resource Council document certain sections are relevant to U.S. employers, especially: 1) Why Hire Immigrants?, 2) Foreign Credentials and Work Experience, 3) Working with Cultural Differences, and 4) Preparing Your Workplace

Good worksheet from the Workforce Innovation and Opportunity Act. Includes specific disadvantaged groups, including a number of cultural groups, immigrants, disabled. It also describes some of the barriers, implications of barriers, and solutions.

Informative resource. Includes specific examples from Portland, Chicago and other U.S. cities. Focuses on the manufacturing industry and how it deals with its ESL workers. Provides specific examples of programs that are effective in helping immigrant workers to overcome the language barrier. The Manufacturing Institute, Center for Workforce Success and Jobs for the Future, Improving Workplace Opportunities For Limited English-Speaking Workers: An overview of practice in the Manufacturing Sector (Washington, DC: National Association of Manufacturers, 2006), pp. 13–14.

From the Small Business Association, with specific suggestions on how to train non-Native English speakers.

Good article based on personal experience, with specific approach to overcoming the language barrier.

Engaging Employers in Immigrant Education (research report)



Image of a female veteran behind the United States of America flagThere are many different employment services for veterans: federal, local, and private non-profits. Veterans often need guidance through the maze of possible vocational services and benefits (financial, medical, and family). It is important to respect the many “cultures” and “subcultures” within the military and the important role that veterans can play in supporting one another in the general recovery and the vocational recovery program.

Deaf and Hard of Hearing:

Hands showing sign language gestureAs with many ethnic groups, those who have both mental health conditions and deafness have to overcome multiple barriers to employment, and there are few professionals who are qualified to serve them. Vocational Rehabilitation agencies typically have been one of the leading providers or funders of services for the deaf (as they relate to employment). They can, for example, provide interpreting services for job interviews or communication equipment.

Employers often need to be educated about how to make the workplace accessible for the deaf and hard of hearing employees through accommodations, such as captioned training videos, interpreting for certain meetings and other specialized supports.

Deaf Culture Online: Many aspects of deaf culture that are not understood by the “mainstream.” These factors are critically important to understand in relation to employment.

Jobs specific to the deaf community


Transition Age Youth

Books on a shelf with a sign that reads Young AdultsYouth with mental health conditions in the 16-25 age group often have grown up with technology and without decades of hospitalization and disability. There is so much hope and potential for young people. There are also unique challenges in getting through the various helping agencies geared for adults. That is why the services and supports designed especially for this age group can be effective. Employment and education along with peer support are key for this age group. The Workforce Investment Opportunity Act (WIOA) is providing additional vocational and educational resources for disabled individuals who are young adults. There is a range of services from tutoring, mentoring to paid and unpaid work experiences and many more. (See Hoff link below).


Further information is available through the Vocational Rehabilitation agency.

Research and Training Center on Transition Youth. University of MA. Medical School

Chalkboard with the word Teamwork written on itNational Collaborative on Workforce and Disability

Successful Transition Models for Youth with Mental Health Needs: A Guide for Workforce Professionals.

Bridging the gap Across Transition. Job Accommodation Network.

Work Early, Work Often Campaign. Transition to Work

Resources for Youth Transitioning to Adulthood


Rural Populations

Gold, P., Meisler, N., Santos, A., Carnemolla, M., Williams, O., & Keleher, J. (2006). Randomized Trial of Supported Employment Integrated With Assertive Community Treatment for Rural Adults With Severe Mental Illness.


Travers-Gustafson, D., Preston, K., & Hudson, J. (2009). Mental Health: Overlooked and Disregarded in Rural America. Center for Rural Affairs.

Rural areas present a number of special challenges for those with mental health conditions. While high school is often the time of onset of illness, fewer rural students may graduate high school. Over a third of African Americans and a quarter of whites in rural high schools do not graduate. Even those who graduate face lower likelihood of achieving employment, post-secondary education, or employment requiring higher-level skills.


Many rural Americans have less access to mental health services than non-rural Americans, and mental health problems tend to be about 2 to 3 greater (Safran, 2009).


Safran, M., Mays, R. A., Huang, L. M., McCuan, R., Pham, P. K., Fisher, S. K., McDuffie, K. Y., & Trachtenberg, A. (2009). Mental health disparities. American Journal of Public Health, 99(11), 1962-1966.


Sunset with a bicycle and rider standing next to itThe risks of unemployment in rural areas remain high considering low levels of education, technical ability, employment experience, and job availability in rural areas. Helping rural residents to find meaningful employment requires strong networking and creativity. Employment Specialist or Rehabilitation Counselors have to have a number of ongoing relationships with the communities they serve in rural areas in order to keep in touch with employment, transportation, and other resources in that area. Telehealth and remote video capacity are also important in rural areas.

Telehealth Use in Rural Healthcare


Lesbian, Gay, Bisexual and Transgendered (LGBT)

Members of the LBGT community, who also have a mental health condition, face at least two forms of discrimination. Encouraging them to have confidence in their particular identity and knowing they are accepted by the family is especially important. It can build a foundation for confidence in the workplace.


The NAMI website outlines a number of challenges the LGBTQ community faces, especially the discrimination on both counts: mental health problems and sexual orientation. There are many resources outlined in this website.

Sign with the word LGBT and the phrase Life Gets Better Together written underneath it


Persons with Forensic History

Those with forensic histories, who also have a mental health condition, may face additional challenges obtaining employment. The first thing that the individual should do is find out what their official criminal offense record (CORI Report) shows. This is available from the state in which the person resides. For additional information about supporting someone with criminal offense history consult our Family Repository.


One website has been dedicated to job finding for persons with forensic backgrounds (not specific to mental health):


Some states have developed Certified Peer Specialists or Forensic Peer Mentors, who have forensic histories specifically to support others with similar histories.


Here is the list by state of the agency which provides the training for Certified Peer Specialists. They may be able to direct you to Forensic Peer Specialists, if they are in that state.


To find out more about this initiative in Georgia, you may contact the Forensic Peer Mentoring Project, Gena Garner, Forensic Peer Mentoring Coordinator at: or 404-723-6018.


California (but similar resources in other states)

Legal Resource Library on Expungement

Free Expungement Resources (by state)