The Immigrant and Refugee Mental Health Project facilitates a virtual Community of Practice (CoP) comprised of health, settlement and social services providers across Canada who support the mental health of immigrants and refugees. The CoP online discussion board allows providers to pose questions to the Project's panel of subject matter experts (SMEs). We will be bringing you some of the questions posed by providers and answers provided by the SMEs.

Dr. Clare Pain, Professor of Psychiatry, University of Toronto, and psychoanalyst; Staff psychiatrist, Mount Sinai Hospital, Toronto writes:

Usually trying to explain Western concepts of mental health doesn’t make much sense to someone raised in a low income country in a different culture. I’d encourage anyone dealing with newcomers not to explain anything about our nosology… (The branch of medical science dealing with the classification of diseases).

But if someone is sad, empathize and inquire why; if someone is angry empathize and inquire why; if someone is anxious or afraid empathize and inquire why…. You get a much more rounded picture of what is troubling that person – so much better than a diagnosis!

And with this client - can you assist her with the very real problems she is experiencing - you may win her trust and reduce the pressures she is under.

Does she have a primary care physician or nurse practitioner? If the twins are hers, what help is she getting? What help would she like, does she feel confident in caring for them? Does she want some respite by putting them in day care for short periods?

What are her reasons for not taking essential medications for her medical condition? What does she fear? Sometimes young people refuse medications because they don’t want to believe they have a chronic condition – it’s a way to control a scary situation.

Being kind, listening with all ears, finding things to talk about that are of interest to her, admiring her ability to handle so much – asking what helps her to be so strong? so hopeful? etc.

Always find a way to connect! Try to explore your own exasperation if you feel this. The only thing that works is kind, positive regard and problem solving!

And given your own interest in helping newcomers - have you considered further training? Training teaches us how to engage clients, how to recognize and work with theirinevitable ambivalence