2022

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.

Question

“What would be the best way to start talking about mental issues with a client if you suspect they may have any?”

Response

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

Question

“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”.

Response

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.

My Journey of Hope. By Teresa Fairbridge, Facilitator/Counselor, Associations for New Canadians, Newfoundland and Labrador

Location:  St. John’s, Newfoundland and Labrador

Quick Facts

• Audience: Settlement, social and health service providers
• Population of Interest: Refugee youth
• The Need:  Deep rooted stigma and unfamiliarity with mental health literacy impeded refugee youths’ ability to access mental health supports.
• What's Promising:  My Journey of Hope introduces refugee youth to the concepts of mental health. Participants use art to express their resilience which they explore through their personal and cultural experiences. The program  seeks to create social support networks through sharing the meaning of art work with small groups of peers. Modules were created for youth, parents and service providers to bridge gaps around mental health in immigrant and refugee communities in Newfoundland.
• Key Takeaway:  The project is centered around community engagement and building community capacity. It employs a multipronged approach which addresses educational needs in the community, creatively engaging youth, and empowering them to champion mental health in their own communities. Grounding the project in a cycle of discussion and feedback with refugee and immigrant youth allowed us to create programs that truly meet the needs of youths and their families.   

Association for New Canadians (ANC)

The ANC is a non-profit, community-based organization delivering settlement and integration services to immigrants and refugees in Newfoundland and Labrador. For more than 40 years, the Association has delivered programs and services that support all aspects of immigrant integration, ranging from settlement information and orientation, to language learning, skills development and employment.

A Three Phase Approach

Stigma, combined with many newcomers’ unfamiliarity with mental health issues prevented many from accessing necessary supports. The Journey of Hope Project joined the Royal Bank of Canada Future Launch initiative to enhance mental wellbeing, empowering youth to create a well-balanced future for themselves.

The initiative is comprised of three phases. Phase one was the formation of the 2gether youth advisory committee and community engagement groups. These groups were involved in discussions which led to the development of three mental health modules for: youth, parents, and service providers. The modules were created to bridge gaps between these populations. The goal is to ensure that the needs of the young people are being met by service providers and that mental health is introduced from a culturally grounded perspective.

The modules, along with additional community feedback, provided the foundation for the second phase which entailed creating, piloting, and training passionate community youth to co-facilitate, The My Journey of Hope program. The third phase is currently offering the program to community youth.

My Journey of Hope Program

This program is a structured, arts-based peer support group which is based in art-therapy, narrative therapy and the peer-support model. Running for 10 sessions, the program provides youth the opportunity to use art to explore and express their existing strengths and resiliency, reflect on their life journey, and create goals. Small group sizes of up to 10 participants provide a safe space for youth to share their art, and its meaning, creating deep social support networks and further enhancing resiliency.

The art encourages the youth to reflect on their own cultural histories and experiences in identifying their personal strengths and resiliency, and empowers them to employ these through difficulties in their lives.

Community youth were provided with training to co-facilitate the groups alongside a certified counsellor. Additional opportunities for certified mental health trainings were also provided to empower youth to be mental health champions in their communities, furthering community capacity.

Program rollout has just begun. Initial feedback on the group has been positive with members commenting that they leave the group feeling calmer than when they arrive for each session. Those that completed the group reported increased confidence, a positive perspective on mental health and feeling connected and supported.


Visit the ANC to learn more.

Simcoe County Local Immigration Partnership public education campaign encourages collective action against racism and discrimination 

Location: County of Simcoe, Ontario

Quick Facts

• Audience: Settlement, social and health services providers and leaders
• Population of Interest: Immigrant and refugee populations
• The Need:  Canada’s population is becoming increasingly diverse as people of different, race, class, culture, ethnicity, religion, and language make Canada their home. However, newcomers can be confronted with intolerance, racism and discrimination based on their social identity. Racism and discrimination are social determinants of mental health and impedes the settlement process on multiple levels. Changing attitudes and behaviour requires intersectoral collaboration.
• What's Promising: The IT STARTS public education campaign mobilizes community partners from different sectors to plan and lead the annual one month media campaign. It works with local citizens and uses the infrastructure and expertise of partners to increase the reach of media messages
• Key Takeaway: The campaign model uses ambassadors and community champions who are willing to engage in collective action to address racism and discrimination. This initiative can be implemented in other communities since the same types of organizations exist in most jurisdictions.

Simcoe County Local Immigration Partnership public education campaign encourages collective action against racism and discrimination.
The Simcoe County Local Immigration Partnership (SCLIP) is a collaborative of community organizations that work together to create settlement strategies for newcomers. SCLIP strategies bring together and support service delivery for immigrants and refugees in Simcoe County, Ontario, while promoting positive relationships, opportunity, and effective use of local resources.

In 2017, the SCLIP and key community stakeholders launched the public awareness campaign with the goal of facilitating dialogue among residents about racism and discrimination, and promote practices that encourage equity, diversity, and inclusion.

The campaign is conducted annually during the month of March. Media messages on social inclusion and acceptance are disseminated in public spaces and through social media channels such as Twitter, Instagram and Facebook. The intervention engages two types of partners: residents as ambassadors and organizations as community champions.

• Ambassadors are persons interested in advancing equity, diversity and inclusion and willing to share anti-racism messages within their formal or informal networks. Ambassadors participate in an information session before the campaign begins and are provided with the resources on how to start a discussion on anti-racism.
• Community champions are organizations from various sectors. Champions are school boards, law enforcement, non-governmental organizations, universities and libraries. They help plan and implement the campaign in their own organization and share messages through their social media platforms to reach their followers.

The campaign is demonstrating positive results. Its reach has been increasing over the years. In 2017 when the campaign began, it reached 1.5 million social media users; in 2021 it reached an impressive 5.1 million users. The number of ambassadors is also increasing each year.

Visit Pathways to Prosperity to learn more about why this is a promising practice or visit Simcoe County’s website for specific information about the initiative.

Immigrant Women’s Peer Support Program, Immigrant Services Society of BC 

Location:  Vancouver and Burnaby, BC

Quick Facts

• Audience: Settlement, social and health service providers
• Population of Interest: Immigrant and refugee populations
• The Need:   Immigrant and refugee women in Canada often experience isolation. Because social support can be difficult to maintain, which can negatively impact mental health, there is a need to facilitate integration of this population to reduce their social exclusion.
• What's Promising:  This program uses a two-pronged approach to decrease social isolation, whereby immigrant and refugee women both lead peer support groups.
• Key Takeaway:  It is important to rethink how immigrant and refugee women can be empowered and included in the development of programs and services to meet their unique needs. This program does so by providing a space where women can apply their own lived experiences to helping others that have similar experiences.

Immigrant Services Society of BC (ISSofBC), one of the largest immigrant-serving agencies in Canada, provides a supportive environment for newcomers to receive settlement support through a fully integrated service delivery model.

The Immigrant Women’s Peer Support Program (IWPSP) provides mental, physical, and social support to immigrant and refugee women experiencing challenges during their integration process. It also trains newcomer women to become peer support group facilitators in their own communities, supporting graduates to serve other newcomer women facing difficulties adjusting to new lives in Canada.

The program has two main components:

• Training: A 100+ hour training program, delivered over a 14 week period, taught by leading experts from various fields. Participants develop and build upon skills to become community leaders and role-models, going on to facilitate support group themselves.
• Peer-Support Groups: Graduates of the IWPSP training go on to facilitate a 10-week support group with the assistance of staff. Peer groups provide newcomer women with a confidential environment to receive support in their settlement challenges, reduce their isolation and forge new friendships.

Program participants have reported an increase in self-esteem and self-confidence, formed lasting friendships, become more aware of services and resources available to them and have gained a better understanding of Canadian culture.

For more information, click here.

Canadian Centre for Refugee and Immigrant Health Care

Location:  Toronto, ON

Quick Facts

• Audience: Settlement, social and health service providers
• Population of Interest: Immigrant and refugee populations
• The Need:  Many newcomers fall through the cracks in Canada’s healthcare systems as service providers, due to varying factors, find it difficult to know who qualifies for care and who does not.
• What's Promising:  This is a free-of-charge Centre that is available to all newcomers who are uninsured or precariously insured – thus dismantling accessibility barriers for those seeking physical and mental health care upon arrival and initial settlement in Canada.
• Key Takeaway:  The Centre is volunteer-run and consists of an interdisciplinary team of health care professionals – making this a one-stop hub-model for service provision. In addition, if a newcomer does not have access to a family physician, they are able to call to book an appointment by self-referral.

The Canadian Centre for Refugee and Immigrant Health Care aims to provide humanitarian medical treatment and assistance to those new to Canada who find themselves medically uninsured and precariously insured. Many newcomers fall through the cracks of Canada’s health care system and are placed within medical limbo.

Service providers, due to varying factors, find it difficult to know who qualifies for care and who does not. This results in several newcomers who need both basic and urgent medical, dental, and psychosocial care turned away. For example, refugees making claims for asylum in Canada are often caught in healthcare limbo without any health insurance when claims are denied or interrupted. In addition, government-assisted refugees are frequently turned away for medical care by doctors and clinics who will not accept their Canadian Federal Health Insurance coverage and new permanent residents accepted by Canada must go without healthcare access for 90 days.

CCRIHC was the first volunteer medical clinic in Canada dedicated to refugees and immigrants. In 1999, the clinic opened with 3 volunteers in a borrowed church basement in a Toronto suburb, and 17 uninsured newcomers were treated. The Centre is a modern medical community clinic with 70 volunteer nurses, nurse practitioners, physicians, and dentists with allied provider support staff that provides medical, dental, mental health and social care.

The Centre provides wrap-around healthcare services for immigrants and refugees, including:

• Community Volunteer Clinic
•  Urban Dental Clinic
• Pediatrics Outreach Program
• SWAN Program
• Dietitian Program
• Chiropody Program
• Diabetes Strong

It also includes a mental health program that provides free, private and confidential counselling for issues related to the unique experiences of refugees and newcomers in their lives prior to arrival, during their journey to Canada and upon settling in the Greater Toronto Area.

The mental health team is comprised of experienced counsellors such as registered social workers/registered psychotherapists who are specialized in culturally-sensitive, trauma-informed psychotherapy for diagnoses such as depression, anxiety, post-traumatic stress disorder, and other mental illnesses. They also provide short-term counselling and referral for psychosocial problems. In addition, support, referral, and advocacy is provided for issues of emergency housing, food access and local community services.

Family physicians and other healthcare providers can make referrals to the Centre. If newcomers do not have a family physician, they are able to call to schedule an appointment and/or be put on a waitlist at the clinic.

For more information on CCRIHC: click here.