The Architecture Of Who Gets Seen

By Cassie Dawalt, One Mind Community Advisory Network

I get the question all the time: why does a straight, cis, white woman from Middle America care so much about equity? If you only look at the surface, it’s a fair question. But my actual life has never been that simple, and it doesn’t fit into those checkboxes. My dad’s siblings are adopted from South Korea, so I grew up with Korean aunts and cousins. My high school specialized in English as a second language, and most of my friend group were first generation students. Every fall, we had “Ethnic” Thanksgiving, and shared recipes from the different countries. My mom spent years struggling with a substance use disorder. I have two brothers—one who is trans and autistic, and another who I helped raise when my mom was struggling. I was the big sister holding it all together while quietly managing my own anxiety, trauma, and a late ADHD diagnosis.

Because my family has touched the mental health and substance use systems from so many different angles, I grew up with a front-row seat to how the exact same structures can be generous to one person and entirely unforgiving to another.

Right now, the world loves to say it cares about mental health. We have awareness months and more mainstream media attention. Don’t get me wrong, I am so grateful for the decreased stigma and awareness, but when you have actually tried to navigate these systems, you learn very quickly that awareness is not access and it certainly doesn’t guarantee retention.

On paper, more care exists than ever. In reality, it isn’t always accessible and it certainly doesn’t always “fit” into real life. 

My first look at how that system is built, and who it leaves out, came through my mother.

She lived with a substance use disorder in a community and culture that had endless vocabulary for being a “good person” and zero language for addiction as a health condition. I wish I could say I understood it was a disease back then, but I didn’t. I just knew it was something we didn’t talk about.

There were stretches when she was in and out of jail, trying to get medication-assisted treatment (MAT) through community clinics. I didn’t talk to her much during that time. I was too busy stepping in to help raise my other brother, carrying around a lot of confusion and quiet resentment.

It wasn’t until I started working in mental health that I started to understand addiction as a disease. Looking back, I can see how behaviors that would have prompted coordinated care for any other chronic illness instead led to handcuffs and court dates for her. I also recognize how much of my community’s stigma I had absorbed without even realizing it. Truly reachable care for my mom would have meant a clinic that could start her on MAT without a six-month wait, treat her like a patient rather than a problem, and offer the family therapy we needed to navigate it together.

Then there is my youngest brother, who is trans and autistic.

He came out to us 13 months before his suicide attempt, right before the world shut down for COVID. We honestly just didn’t know what to do; we didn’t have the resources, the language, or the roadmap for what he was going through.

Then came the part nobody warns you about: finding care afterward. For a trans, autistic young person living in Missouri, the reality of those options looked nothing like what the directories suggested. We hit waitlist after waitlist. We filled out intake forms that couldn’t even accommodate his name or pronouns. We met with providers who advertised as “LGBTQ+ affirming” and then misgendered him in the very first session. The system expected him to have the executive function of a project manager to navigate portals and unreturned voicemails, at a time when he was already exhausted just trying to stay alive.

Care that exists in a directory is useless if it cannot find you in your real life, your identity, and your capacity. Reachable care means actually meeting people exactly where they are.

All of this was happening while I was busy being the “responsible” one.

I was in therapy. I was on Prozac. From the outside, I was highly functioning. Internally, I was managing symptoms inside a story I didn’t fully understand. I finally did what I told everyone else to do and made an appointment with a psychiatrist.

In just one visit, I felt so seen it was like I had walked into a psychic’s office rather than a psychiatrist’s: I was diagnosed with Anxiety, Trauma, and ADHD. Being diagnosed with ADHD at 32 pulled a thread through my entire life. It explained the constant mental noise. It explained how I could build complex strategies for work, yet forget basic tasks at home. It didn’t mean I was broken. It meant my brain had been working overtime to keep up with expectations that were never designed with me in mind.

Care existed for me, but it still took years of privilege, access, and persistence to get in front of someone who could see the whole picture. Most people never make it that far.

Today, I sit in rooms where people talk about access, equity, and innovation. Through One Mind’s Lived Experience Council and the Community Advisory Network, I’m grateful to be able to bring my family’s reality into the conversations where the next chapter of mental health strategy is being drafted.

We are at a critical turning point. Care isn’t just clinics and hotlines anymore; it is apps, algorithms, and AI tools sliding into the space between people and help.

If we let bias and convenience drive the design of these tools, we will simply digitize the current system and scale the exact same inequities my family faced. But we have a rare opportunity to do this differently. We can use AI to truly meet underserved populations where they are at. We can use data to notice when someone keeps hitting barriers and actually redesign the path, rather than just labeling them “non-compliant” or finding the most cost effective solution.

This only happens if lived experience, clinical quality and cultural competence are the starting point, not a focus group run at the end of the design process. In One Mind’s lived experience spaces, we aren’t there to decorate strategy decks with our trauma. We are there to pressure-test ideas against reality. To ask: Who does this actually help? Who does this miss?

If my family has taught me anything, it’s this: if you make sure things work for the people most likely to fall through the cracks, everything works better for everyone else. The disconnect between care existing and care actually reaching people isn’t just bad luck. It’s a choice, and it’s up to us to start making better ones.

If you sit on a board, at a health plan, or in a C-suite, you are making those choices right now. Before you greenlight another access strategy or AI tool, ask yourself: Who with lived experience helped design this from the start? And who are we still asking to navigate around it?

One Mind’s Lived Experience Council and Community Advisory Network exist because some of us refused to keep our stories separate from the systems we build. The invitation is simple: Build with us, not around us.