Post migration trauma is a commonly under-looked but important risk factor of poor refugee mental health.

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1 Post migration trauma is a commonly under-looked but important risk factor of poor refugee mental health. Skoll Global Challenge Team: REACH Khayla Almonte-Davila, Katie Mai, Fehintola Okunubi Simon Fraser University

2 Problem Landscape Canada welcomed 39,671 Syrian refugees between November 4, 2015 & January 2, This number is expected to rise, and it doesn t include refugees arriving from other countries (Government of Canada, 2017). A report by the Mental Health Commission of Canada stated that Canada is adequately positioned to provide incoming Syrian refugees with support for good mental health (Agic et al., 2016). However, previous research has shown that refugees face many hardships after arrival that negatively impact their mental health, leading to postmigration trauma of refugees in Canada. For example: refugees to Canada experience high rates of post-traumatic stress disorder, psychosis, and depression, with increased rates of mental health problems in refugee children (Agic et al., 2016). There are three main types of refugees arriving to our country: privately sponsored refugees (PSR s), who arrive through the support of private groups, government-assisted refugees (GAR s), who arrive through government sponsorship, and refugee claimants, who claim refugee status upon arrival (Surrey Local Immigration Partnership, 2015). In addition, the Canadian Government has the Blended Visa Office-Referred Program in which the Government and private sponsors co-support a refugee. (Government of Canada, 2014). Some of these refugee groups are at higher risk of post-migration trauma due to their status. However, all three groups face systemic barriers that are shown to increase the incidence and severity of post-migration trauma (Agic et al., 2016). In Canada, the four biggest barriers impacting refugee mental health are language, unemployment, discrimination, and acculturation. For this report, we focused on refugees in British Columbia (B.C) due to an abundance of personal conversations with refugees and service providers in Surrey and Vancouver. For refugee newcomers, lack of language proficiency has a strong impact on postmigration trauma, as it impedes access to services, hinders employability, and limits participation. For example, through interviewing refugees at an adult education center in Surrey, BC, which included youth, we discovered that interpretation services in hospitals were inadequate (October 2016). As a result, people have to rely on their social networks for interpretation. This is not a reliable method since the individuals providing interpretation often do not have a solid command of both languages, particularly with medical terminology. Additionally, many refugees do not have those connections (October 2016). Although language barriers affect all refugees, it is the most isolated newcomers (the women, children and elderly) who are least likely to learn and practice english (Beiser, 2009). These groups are particularly at risk of severe isolation and the mental health consequences correlated with it. Discrimination is shown to be strongly correlated with high levels of post-migration trauma (Beiser et al., 2016). Its impact on mental health is both direct and indirect. For example, discrimination can impact refugees economically, making it challenging to find housing, acquire and keep jobs, and receive equitable wages (Beiser, 2009). This leads to high unemployment rates and low quality of life. Moreover, discrimination can impact the psyche directly by damaging self-esteem and inciting feelings of incompetence (Beiser, 2009). This is also a common theme that emerged from our interviews with refugees. Despite speaking to a diverse group, we found that they shared similar experiences of discrimination at work, school

3 and in other public places. These experiences ranged from microaggressions, such as racial slurs, to systemic racism, such as inability to find housing (Refugee focus group, Personal connection, October 2016). Unsurprisingly, these experiences contribute to increased rates of post-migration trauma. Among the three types of refugees arriving to Canada, it was found that privately-sponsored refugees felt most supported, and thus, had fewer incidences of postmigration trauma. This was primarily due to the connection they had to their sponsor group (Refugee focus group, personal connection, October 2016). While it appears that Canada s policies are quite welcoming to refugee newcomers, anti-refugee discrimination is still rampant among the local Canadian population. It is shown that Canadians associate refugees with crime, welfare fraud, and unjustly jumping the immigration queue (Beiser et al., 2016). Therefore, although Canada is internationally recognized for their positive treatment of refugees, in truth, systemic racism continues to play a role in creating and affecting mental health problems among refugees. Similarly, acculturation, the adaptation of and integration into Canadian culture by refugees, is also a post-migration challenge that impacts the mental health of refugees settling in Canada. This is intricately correlated with discrimination, as studies show that discrimination decreases with increased cultural integration. This may be due to refugees decreased participation in the broader society. Therefore, the more closely integrated a refugee is into the broader Canadian society, the lower their risk is of poor mental health (Beiser, 2009). Furthermore, the differences in culture that exist between newcomer populations and the broader Canadian society result in varying perceptions of mental health and and health care services. This can negatively impact refugee mental wellness through a number of avenues. Firstly, refugees have expressed that they do not trust authoritative figures due to their fear of institutions that was fostered during their time in their home countries. Unfortunately, this includes many refugee-focused services, such as settlement workers, doctors, and counsellors. During our interviews, participants expressed that they feared their children would be apprehended if they visited these services (Refugee focus group, Personal connection, October 2016). Secondly, there is stigma that exists around accessing mental health services. Therefore, newcomers are less likely to want to seek support when needed. This barrier exist on top of other challenges such as transportation, language, and time available. Together, these challenges combine to make it very difficult for refugee newcomers to receive the support they need when they face post-migration trauma (Refugee focus group, Personal connection, October 2016). Underemployment and unemployment also contribute to a refugees mental health. Oftentimes, refugees take jobs they are overqualified for. An individual could have been a well paid doctor in their home country, but is unable to find work as a doctor in Canada, finally resorting to taking low income jobs. This could be due to an employers distrust or unfamiliarity of foreign credentials, and language issues. This drastic change in circumstances and income could be demoralizing and detrimental to one's mental health (Beiser et al., 2001). Many refugees feel rushed to find employment in order to pay off loans from the government (Meghan M., Personal connection, October 2016). This is especially prevalent in GAR s, as they are required to pay back the initial funding they are given from the government (City of Surrey,

4 2017), which is supposed to be used to give them time to settle in before finding a job. This funding includes the Transportation Loan, which is money spent by the Canadian government on GAR s prior to arriving in Canada. The transportation loan subsidizes the cost of pre-entry medical exams, transportation documents, and transportation costs (City of Surrey, 2017). Since many refugees prioritize employment over english classes to pay off the loan, they cannot afford to take the time to properly adapt to the culture and social norms. Due to insufficient english skills, many are stuck in low paying, unfulfilling jobs, creating a large amount of additional mental pressure (Sidhu C., personal connection, October 2016). Sometimes, even menial jobs are not given to overqualified, well-educated refugees, further negatively impacting refugees mental health (Agic et al., 2016).

5 Solutions Landscape We first researched the process of resettlement for the USA because it was the top country for refugee resettlement in 2015 (Resettlement fact sheet, 2015), but found that the services available were similar to those in Canada. Therefore, we focused our research on Canadian services, particularly on programs in British Columbia due to accessibility to meet in person. The solutions landscape is broad, encompassing four organizational levels: global, federal, provincial and local. Globally, there are various organizations working to help the refugees in their home countries, such as the Red Cross. However, this discludes working on facilitating the resettlement process, and instead focuses on providing resources prior to resettlement. Global organizations do provide an abundance of knowledge around discrimination. The Federal Government has various programs to assist with resettlement depending on the type of refugee. Federal loans are available to all refugees through the Immigration Loans Program, mainly to put towards housing and food. GAR s are eligible for the Resettlement Assistance Program (Government of Canada, 2017). This one year program provides accommodations support, linkage to federal and provincial programs, a needs assessment, and an orientation to life in Canada (2017). Little support is given to privately sponsored refugees, with the assumption that they will get assistance from their own sponsors. Provincial assistance programs use a top-down approach to cater to different resettlement demands. Most of these organizations help in the process of resettlement, particularly targeting language, housing, employment, counselling, and childcare. In B.C, all refugee must go through the Immigrant Services Society (ISS), a provincial government service. It has various programs which pertain to a specific need such as: Employment (assessment of credentials), Skills Connect For Immigrants, Maple 2.0 Mentorship, Skills and Support for Job Success (Immigrant Services Society, 2017). Enrolment in the programs is competitive with various factors being taking into consideration. For example, individuals need a certain level of english to be considered for Maple 2.0 Mentorship. Also, the sessions for the programs are sparse with limited capacity. After speaking with a focus group of refugee, we found majority were unaware of these programs and were more likely to use a private organization (Refugee focus group, Personal connection, October 2016). On the other hand, the private, grassroots organizations are the frontline workers in resettlement efforts. Similar to the ISS, these organizations have a variety of programs that meet different needs of the refugee. Table 1 provides examples of private organizations in the Lower Mainland.

6 Table 1: Examples of local private organizations helping with refugee resettlement Organization DiverseCity Kinbrace Mosaic Options BC Need(s) Met Settlement Support Housing Employment, counselling, health services, language Language, housing, counselling, crisis line As frontline workers with less policy and bureaucracy, the local, private organizations have the ability to create deeper connections with the refugees. The refugees that have formed these stronger relationships tend to have an easier time resettling, which results in better mental health (Refugee focus group, Personal connection, October 2016). However, due to limited awareness, unfamiliarity with language and hardships with transportation, these organizations are not utilized to their full potential (Maria, Personal connection, October 2016). Furthermore, although there is a plethora of language and employment services available, the opposite is true for acculturation and discrimination. These underlying social issues must be addressed in order for refugees to feel welcomed into Canada, further creating an easier transition.

7 Lessons and Levers of Change From our research and personal conversations, we concluded the following lessons and levers of change: Social connections may be the answer We found that most refugees who have comfortably resettled had strong support networks and deep social connections with either their private sponsors, or other organizational frontline workers. This can also increase awareness of programs available to the refugees. Shifting narratives The pressures refugees feel to assimilate into the Canadian culture is unfair. Currently, there is a singular narrative of the vulnerable refugee, which adds to an already determined power inequality between the newcomers, and Canadian citizens. Canadians must begin to understand home country culture of the refugee so everyone can embrace diversity. Focus on empathy rather than sympathy. Educational scholarships Scholarships can be provided for refugees who want to work in mental health services, which will improve job satisfaction. It will also benefit incoming refugees, as they will relate better with their service providers. This further strengthens social connections and removes stigmas around mental health services. Decrease pressures to pay back loans Transportation loans are shown to be a huge mental burden. Currently Syrian refugees are exempt from paying this loan, it is only fair that all other refugees be treated equally. If this is not possible, at least cancel interest on payments.

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