Prepared for CCR workshop participants of/ Préparé pour les participants à
Addressing Newcomer Mental Health in Settlement
La santé mentale des nouveaux arrivants et les services d’accueil
24 November 2016
Prepared by/ Préparé par William Payne and/et Billy Ilunga Kalenga
Refugee Research Network
(Centre for Refugee Studies/ Centre d’études sur les réfugiés, Université York University)
With advice from/ Avec de conseils de Sajedeh Zahraei
Mental health issues newcomers face
Agic, Branka, Kwame McKenzie, Andrew Tuck and Michael Antwi (2016) “Supporting the mental health of refugees to Canada,” Mental Health Commission of Canada.
In the context of Canada’s response to the current refugee crisis, these authors seek to offer advice regarding how best to provide a coordinated mental health response to the needs of arriving newcomers. They seek to promote a national dialogue around a coordinated response. They underline that Canada has the capacity to provide good mental health support and that while there are gaps in necessary knowledge there is already a body of evidence to guide the provision of services. They underline the importance of a coordinated and funded response to the mental health needs of arriving refugees.
Pumariega, Andrés J., Eugenio Rothe and JoAnne B. Pumariega (2005) “Mental health of immigrants and refugees,” Community Mental Health Journal 41(5): 581-597.
These authors review risk factors and mental health needs of immigrants and refugees and propose treatment and service approaches. The article provides a succinct overview of pre-migration, migration and post-migration stressors that newcomers face and also outline the relevance of cultural identity and related acculturation stress. The authors conclude with an articulation of the principles of culturally competent mental health services and related interventions to promote successful resettlement.
Kirmayer, Laurence, Lavanya Narasiah, Marie Monoz, Meb Rashid, Andrew G. Ryder, Jaswant Guzder, Ghayda Hassan, Cécile Rousseau, Kevin Pottie (2011) “Common mental health problems in immigrants and refugees: general approach in primary care,” Canadian Medical Association Journal 183(12).
These authors identify key risk factors and strategies that should be kept in mind in relation to mental health issues of immigrants and refugees. They found that at the time of arrival, immigrants exhibit lower level of mental health issues than the average but that over time prevalence rates rise to levels among non-immigrants. Those refugees who have been exposed to violence tend to exit trauma-related health issues including PTSD, chronic pain and other health issues. These authors recommend that newcomers be assessed for risk for mental health problems related to pre-migration exposures as well as stresses experienced during both migration and the resettlement process. They also find that trained interpreters and cultural brokers are important for effective assessment and treatment of mental health problems and discourage reliance on family members or untrained persons for these roles. This paper underlines that mental health issues and treatment for specific subgroups among newcomers including women, adolescents, children and seniors that have specific modalities that should be kept in mind. They remind their readers that there are cultural dimensions to illness experience that impact all aspects of mental illness. The authors also point out that newcomers are sometimes more likely to discuss psychosocial stressors outside medical settings because they believe that such factors are not relevant medical issues. They also point out that the promotion of mental health and the prevention and treatment of mental illness should take into consideration the role of family and community organizations in addition to the rights to individual autonomy and privacy.
Factors associated with psychological distress among newcomers
Briggs, Lynne and Lesley Cooper (2015) “Demoralization: Exploring the post-migratory experiences of newcomers resettling in Canada,” Journal of Sociology and Social Work 3(2): 17-26.
These researchers studied the relationship between psychological well-being and post-migratory experiences among a group of newcomers who had resettled in Canada. They found that most participants in their study were experiencing a mild level of demoralization, defined as “a persistent inability to cope, resulting in associated feelings of helplessness, hopelessness, meaninglessness, subjective incompetence and diminished self-esteem.” They noted that many newcomers follow a known pattern that includes a phase marked by demoralization 6-12 months after arrival. A key finding of their research is that employment appropriate to qualifications and skills is strongly associated with lower levels of demoralization. The researchers also confirmed that language support, social networks, a community identity, feeling accepted by the host society, and being able to participate in community and social activities are associated with successful settlement.
Cleveland, Janet, Cécile Rousseau, and Rachel Kronick (2012) The Harmful effects of detention and family separation on asylum seekers’ mental health in the context of Bill C-31. Brief submitted to the House of Commons Standing Committee on Citizenship and Immigration concerning Bill C-31, the Protecting Canada’s Immigration System Act.
In this brief, the authors outline the deleterious mental health implications for adults and children who are held in short- or long-term immigration detention. They outline research that shows that even short-term detention has significant mental health effects that impact mental health well after the end of detention. Because of the evidence, the recommend that alternatives to detention be adopted, that the use of detention be reduced, and that certain groups be exempt from detention including minors and their children, pregnant women, and people with mental or physical illness that could be aggravated by detention.
Newcomers forge their own futures
Watters, Charles (2001) “Emerging paradigms in the mental health care of refugees,” Social Science & Medicine 52: 1709-1718.
This author rejects models for mental health care that see refugees as passive victims and instead pays attention to resistance of refugees, how they interpret and respond to what they have faced. The paper considers several issues concerning the mental health care of refugees and identifies several emerging paradigms in the area of mental health care that includes holistic approaches that pay attention to the experiences and expressed needs of the refugees themselves. The author proposes a model for the analysis of refugee mental health that goes beyond labeling and diagnosis.
Marlowe, Jay. M (2010) “Beyond the discourse of trauma: Shifting the focus on Sudanese refugees,” Journal of Refugee Studies 23(2): 183-198.
This author points out that the designation of the legal status of “refugee” can end up defining people in ways that supersede other identities. The article proposes a “more sophisticated understandings of how people have responded to trauma” that go beyond sensational storytelling about trauma and includes the ordinary ways refugees respond to their own extraordinary experiences as they look towards their own futures.
Social determinants of mental health among refugees
Simich, Laura, David Este and Hayley Hamilton (2010) “Meanings of home and mental well-being among Sudanese refugees in Canada,” Ethnicity & Health 15(2): 199-212.
These researchers consider the family and social factors relevant to refugee mental health during settlement. Their research focuses on the concept of ‘home’ as a key concept relevant to the lived experience of newcomers through the resettlement period. They identify the social supports associated with ‘home’ for a particular group of refugees that are key to mental health, including access to emotional support, the fulfillment of social roles and expectations, availability of problem solving and conflict resolution, and the possibility of dignity and growth. They conclude that service providers should seek to incorporate these qualities of home into their work in order to facilitate newcomer well-being.
Wood, Jennifer and K. Bruce Newbold (2012) “Provider perspectives on barriers and strategies for achieving culturally sensitive mental health services for immigrants: A Hamilton, Ontario case study,” International Migration & Integration 13: 383-397.
This study used interviews with service providers to identify barriers to and strategies for improvement of mental health care for newcomers. The authors recognize that several key determinants are associated with reduced mental health outcomes of some newcomers including lack of family/community support, employment status, level of education and inadequate housing. They identified three main barriers to adequate mental health care for newcomers: a lack of cultural competence among care givers, stigma and shame issues related to mental illness, and inadequate resources for services for newcomers and for the material needs of newcomers themselves. They recommend increased funding for mental health services, cultural competency training for providers, and improved language and interpretation supports.
Wilson, Ruth Marie, Rabea Murtaza and Yogendra B. Shakya (2010) “Pre-migration and post-migration determinants of mental helath for newly arrived refugees in Toronto,” Immigrant Mental Health. Public Health Agency of Canada and Metropolis.
Full document available here: www.metropolis.net/pdfs/immigrant_mental_health_10aug10.pdf
These authors consider determinants of mental health for refugees both before and after arrival in Canada. Pre-migration stressors include war, violence, torture, persecution, precarious migration and protracted stays in refugee camps. These experiences have resulted in gaps in both educational and vocational opportunities. They recommend mental health services that assist in overcoming PTSD and other trauma, a reduction in economic uncertainties during resettlement through the elimination of the transportation loan repayment requirement, enhanced language training and employment preparation that is oriented to the specific needs of the refugees, a process for addressing discrimination in Canadian society, the delivery of newcomer services based on a rights-based framework, and the inclusion of refugee groups in research, policy development and decision-making.
Adolescent refugee mental health
De Anstiss, Helena and Tahereh Ziaian (2010) “Mental health help-seeking and refugee adolescents: Qualitative findings from a mixed-methods investigation,” Australian Psychologist 45(1): 29-37.
This study starts to address the lack of research concerning the mental health care of adolescent refugees. The researchers find that most adolescent refugees are reluctant to seek help in relation to psychosocial problems for a range of reasons including the lack of appropriate services, their unfamiliarity with mental health issues and services, a perception that mental health professionals are not trustworthy or helpful, and stigma regarding mental illness. The authors recommend that mental health services develop trust relationships with refugee communities through organized outreach programming and provide services designed specifically for adolescent refugees. They also recommend school-based programs that develop mental health literacy and further research concerning the development of culture-specific services for refugee adolescents that incorporate cultural meaning systems and healing practices.
Ellis, B. Heidi, Alisa B. Miller, Heather Baldwin and Saida Abdi (2011) “New directions in refugee youth mental health services: Overcoming barriers to engagement,” Journal of Child & Adolescent Trauma 4: 69-85.
These authors identify key barriers to successful resettlement of some refugee youth that need to be addressed including distrust of authority, stigma attached to seeking mental illness, the lack of culturally appropriate services, the lack of services in the refugee’s mother tongue, and challenges related to securing adequate food, housing and employment that necessitate deprioritization of mental health issues. Given that refugee youth tend to seek assistance for mental health needs from ‘gateway providers’ including parents, teachers and family doctors, these researchers document the success of a community based project that incorporates these actors in efforts to address mental health needs of refugee youth.
Trauma and Newcomers
Savic, Michael, Anna Chur-Hansen, Mohammad Afzal Mahmood and Vivienne M Moore (2016) “ ‘We don’t have to go and see a special person to solve this problem’: Trauma, mental health beliefs and processes for addressing ‘mental health issues’ among Sudanese refugees in Australia,” International Journal of Social Psychiatry 62(1): 76-83.
These authors start from the premise that while much refugee mental health research has focused on trauma, there is nevertheless uncertainty regarding whether this research corresponds with the needs, beliefs and healing practices of refugees themselves. The study included indepth interviews with both refugees as well as health and social work professionals. Not all refugees consider the concept of trauma as salient to their lives and instead prioritized stoicism and a forward-looking focus as more useful than western psychological therapies. The authors recommend greater dialogue between service providers and community members to figure out which strategies and processes are most appropriate for individual refugees.
Simich, Laura, Lisa Andermann, Joanna Anneke Rummens and Ted Lo (2008) “Post-disaster mental distress relief: health promotion and knowledge exchange in partnership with a refugee diaspora community,” Refuge 25(1): 45-54.
This article reports on the experience of a network that formed in Toronto in 2004 to address the mental health needs of an immigrant community in the aftermath of a disaster in their homeland. Researchers, medical professionals and community service providers formed a network to provide information, referrals and care for affected members of this community.
Mental health promotion programs
Kobus-Matthews, Marianne, Branka Agic, Angela Loconte, Kristin De Maeyer, Uppala Chandrasekera, Suzanne F. Jackson and Holly Easlick (2012) Best practice guidelines for mental health promotion programs: Refugees. Centre for Addiction and Mental Health, Dalla Lana School of Public Health (University of Toronto) and Toronto Public Health.
This resource provides service providers with concepts and principles to guide mental health promotion for refugees. The authors hope that this document will assist in the development of initiatives and programs for refugees. This document includes a series of guidelines for mental health promotion initiatives as well as examples of good practice.
Corneau, Simon and Vicky Stergiopoulos (2012) “More than being against it: Anti-racism and anti-oppression in mental health services,” Transcultural Psychiatry 49(2): 261-282.
This paper reviews efforts to address racism and oppression in mental health and social services and reduce their negative outcomes. They identify a series of anti-racism and anti-oppression strategies that are being deployed, including empowerment, education, alliance building, language, alternative healing strategies, advocacy, activism, and the encouragement of reflexivity. These authors argue that these frameworks should be further studied to understand how they might be further incorporated into service delivery
La santé mentale chez les réfugiés
Agic, Branka, Kwame McKienzie, Andrew Tuck et Michael Antwi (2016) “Appuyer la santé mentale des réfugiés au Canada.” La Commission de la santé mentale du Canada.
Disponible à: https://cdp-hrc.uottawa.ca/sites/cdp-hrc.uottawa.ca/files/2016-santementaledesrefugies.pdf
Ce document parle de la réponse du Canada à la crise des réfugiés syriens en termes de la promotion et de la prévention des problèmes de la santé mentale et la façon dont les services sont offerts à cette catégorie de réfugiés. Il passe en revue les progrès réalisés par la Commission sur la santé mentale, des données existantes et donne des recommandations pour aider la Commission à faciliter l’intégration des réfugiés syriens au Canada par des services de santé mentale adéquats.
Troubles de santé mentale dans les groupes culturels
Levesque, Annabel et Rhéa Rocque (2015) “Représentations culturelles des troubles de santé mentale chez les immigrants et réfugiés de l’Afrique francophone subsaharienne au Canada.” Alterstice 5(1): 69-82.
Disponible à: https://www.journal.psy.ulaval.ca/ojs/index.php/ARIRI/article/viewFile/Levesque_Alterstice5(1)/126
Cet article parle des causes, de la trajectoire et des traitements des troubles de santé mentale chez les immigrants et réfugiés africains francophones du sud du Sahara. Ces réfugiés connaissent les mêmes causes de troubles liés aux mêmes trajectoires migratoires. Les causes communes sont notamment les facteurs sociaux comme le stress, la séparation brusque d’avec les membres de leurs familles, la rupture avec leur statut socio-économique tandis que parmi les causes individuelles se trouvent notamment les facteurs individuels tels les comportements. A ces facteurs s’ajoutent les facteurs biologiques et génétiques et les facteurs surnaturels. L’article parle enfin des stratégies de traitement ou de contrôle notamment le soutien social, ‘intervention médicale psychothérapeutique et traditionnelle ou religieuse.
Immigrants en bonne santé
Vang, Zoua, Jennifer Sigouin, Astrid Flenon et Alain Gagnon (2015) “L’effet de la sélection de l’immigrant en bonne santé au Canada.” Un Réseau stratégique de connaissances Changements de population et parcours de vie – Document de travail. Vol. 3, Iss. 2, Art. 6.
Disponible à : http://ir.lib.uwo.ca/pclc/vol3/iss2/6.
Cet article parle de la sélection de la migration internationale qui s’effectue su niveau individuel et au niveau étatique. Les auteurs y font mention des raisons qui fondent cette pratique de sélection. Les caractéristiques individuelles telles la langue d’accueil, l’éducation, l’expérience du travail et autres compétences sont liés à la santé de la personne qui immigre. Ces caractéristiques sont des facteurs de succès sur le marché de travail. L’article compare aussi les problèmes de santé entre les populations nées au canada et les immigrants en utilisant les mesures de la mortalité, la santé générale auto-déclarée, la santé mentale, les maladies chroniques, les limitations fonctionnelles ou les invalidités, les comportements à risque ainsi que la santé prénatale et la santé des enfants et des adolescents.
Amélioration des services de santé mentale
Bartram, Mary, Howard Chodos, Sarah Gosling, Susan Lynn Hardie, Francine Knoops, Louise, Lapierre, Donna Lyons et Barbara Neuwelt (2012) “Changer les orientations, changer des vies: stratégie en matière de santé.” Commission de la santé mentale du Canada.
Cette étude est une stratégie qui vise l’amélioration du système de santé mentale en vue de l’adapter aux besoins de personnes de tout âge et de leurs proches. Il y est fait mention des enjeux et des changements proposés en vue d’améliorer le système. Il s’agit de vaincre la stigmatisation, la discrimination et la crainte d’être étiqueté. Ces enjeux et stratégies visent le traitement et la promotion de la santé mentale auprès de toute la population en vue de la prévention de ces troubles. Priorité 4.2 se concentre sur la amelioration des service et les forms de soutien en santé mentale destines aux immigrants, aux réfukgiés et aux membres des groups ethnoculturaels ou racialisés.
Nécessité des services de santé mentale
Kirmayer, Laurence (2012) “La santé mentale chez les immigrants et les réfugiés.” Quintessence 4(7).
L’article parle en premier lieu de la nécessité d’offrir des services de santé mentale en raison des facteurs spécifiques qui affectent les réfugiés depuis les pays d’origine ou de provenance comme la violence, la torture, le stress post-traumatique, la dépression et les symptômes somatiques. L’article mentionne aussi les difficultés liées au processus d’immigration ainsi que l’interprétation et l’accès aux services de santé mentale. Parmi ces difficultés se trouvent la rupture des réseaux et liens familiaux, la transition socio-économique, le sous-emploi, le chômage, la pauvreté, le racisme, le nouveau système éducationnel chez es jeunes. Quant à l’interprétation et l’accès aux services de santé, l’article mentionne la culture comme facteur influent sur nombreux aspects de la maladie mentale.
Arguments en faveur de la diversité
McKenzie, Kwame, Emily Hansson and Andrew Tuck (2009) Améliorer les services en santé mentale pour les immigrants, les réfugiés et les groupes ethnoculturels ou racialisés: Enjeux et options pour l’amélioration des services. Commission de la santé mentale du Canada et Centre de toxicomanie et de santé mentale.
Cet article parle des enjeux et des options qui visent l’amélioration des services en faveur des groupes défavorisés par la culture et la race. Il passe aussi en revue les données disponibles sur la diversité au Canada et sur l’accès aux services de santé mentale par les immigrants et les réfugiés. Ces enjeux sont notamment le vieillissement, les jeunes, l’orientation sexuelle et les enjeux liés à chaque sexe. Il évoque, en outre, les trois aspects où se situent la problématique des services de santé chez les immigrants et les réfugiés à savoir: les déterminants sociaux, le taux des maladies mentales et les obstacles aux soins. Il évoque, en fin, la migration, la discrimination et les difficultés linguistiques comme déterminants sociaux qui retardent l’accès au traitement avant de formuler des recommandations. Cette étude a été réalisée au Québec, en Colombie britannique et en Ontario.