Q & A with Vanessa Wright and Dr. Clare Pain
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.
“What would be the best way to start talking about mental issues with a client if you suspect they may have any?”
Response by Vanessa Wright, nurse practitioner, Crossroads Refugee Health Clinic
Great question. Creating a rapport and establishing elements of support within a provider/client relationship can take several visits - admittedly this is harder through the confines of virtual care. I often find opening up the dialogue and inquiring about appetite and sleep are non-intrusive ways to explore a client's mental health. If through these questions, little is shared and there is a sense that additional mental health exploration would be helpful, reminding the client your role, the confidential space you are in, ways to reach you for added conversation - and discussing aspects of health navigation can be helpful as gentle supports. Booking an appointment in the near future may also be helpful to continue to establish rapport and a supportive environment.
If a client does admit to a change in their sleep or appetite - assessing the client's interest or pleasure in doing things could be explored as well as general energy levels. If there is an admitted shift/change in any of these areas, further assessment by a medical professional would be encouraged.
I have provided a website that very nicely explores tips for talking about mental health. Although it is UK based, I quite like the way this subject is approached: https://www.mentalhealth.org.uk/publications/supporting-someone-mental-health-problem
“I'm interested in asking the whole panel of experts what they think, in their expertise and experience, are the greatest barriers newcomers face to accessing adequate mental health care in Canada, and any proposed solutions”.
I think the biggest barrier to receiving mental health care is the lack of primary health care! Its essential that all refugees sign up with a primary health care practice – which is not always easy outside the big hubs. Although there are some good walk-in clinics. But it is the first step in any care, and especially mental health – the family doctor can do a full physical assessment and rule out other causes of problems and also attend to mental health problems.
The other essential for most refugees is the need for settlement services – aimed at addressing the most compelling newcomer needs. Sometimes caregivers, teachers etc. think moving straight to mental health services is the answer. However the pyramid of health care is important to remember – and that the most foundational layer is the social determinants of health – housing, adequate income to buy food, transportation, work, school etc. Mental health services is the smallest piece at the top. Of course for a psychiatric emergency like acute suicidality - the EM should always be available.