Immigrant Mental Health: Overcoming Health Disparities Canadian Public Health Association Centenary Conference Toronto, 16 June 2010 Nazilla Khanlou RN, PhD (OWHC Chair in Women s Mental Health Research, Faculty of Health & Associate Professor, School of Nursing, York University) (Presenter) & Tahira Gonsalves MA (Research Coordinator, Office of the OWHC Chair, York University)
Context Increasing ethno-cultural and linguistic diversity in Canada with immigration 250,000 newcomers to Canada annually (CIC, 2008) 1 in 3 Canadians could be a member of a visible minority group in 2031 (Statistics Canada, 2010) Majority of immigrants settle in Toronto, Vancouver, and Montreal 2
Defining Mental Health WHO s well-known dictum there is no health without mental health Not just an absence of mental disorders, but also wellbeing, flourishing, and resilience Determined by socio-economic and environmental factors Linked to behaviour 3
Literature Review Intersectional and systems approach Intersectionality: recognizing the multiple and intersecting influences involved in identities and social relations Systemic approach: recognizing the individual (micro), intermediate (meso), and systems (macro) level influences on any given social phenomenon (Khanlou, 2009 a & b) 4
Individual Influences Age Lifestage differences are important but limited research Gender and sexuality Different health outcomes for men and women Insufficient research on sexuality Ethno-cultural background and religious/spiritual identities Cultural variations in conceptualizations of mental health Religion/spirituality can form a supportive role 5
Intermediate Influences Family and social support networks Reliance on extended family members Social networks (ethnic communities, religious organizations) Acculturation Integration linked with positive mental health outcomes Variable findings within context of discrimination 6
Systems Influences Economic barriers Underemployment or unemployment significant risk factor for mental health of individual and entire family Appropriate services Culturally sensitive, specific, and coordinated 7
Systems Influences continued Migration status and access to healthcare Differential access, pre-migration status Prejudice, discrimination, and racism Impact on mental health 8
Research Example: Newcomer Youth Mental Health Project Funded by Provincial Centre of Excellence for Child and Youth Mental Health at CHEO (2007-2009) Community-academic partnership (Access Alliance & University of Toronto) Dr. Nazilla Khanlou (PI) Dr. Yogendra Shakya (Co-PI) Dr. Carles Muntaner (Co-I) Community-based research (CBR) Youth Advisory Committee (YAC) Peer Researchers (PRs) Mixed methodology Focus groups and interviews with newcomer youth (14-18, arrived within last 5 years) and parents from Afghan, Colombian, Sudanese, and Tamil communities, and services providers 9
Project Objectives Explore diverse conceptualizations of mental health & illness; Explore needs & help-seeking behaviours; Explore access barriers to services; Propose policies and practices to remove barriers; and Actively engage newcomer youth in the research process 10
Language Fluency At the individual level, lack of fluency in English as well as a non-canadian accent posed a significant challenge for youth Not me but in general people make fun of English and accents. But I knew some English before I came so that helped (Afghan female participant, 16 years old) 11
Labour Market Security At the intermediate level, lack of labour market security (unemployment and underemployment) for parents, had significant negative impacts on the entire family My dad was a professor in India and my mom s a doctor when they came here, they said that they need Canadian experiences or their English is not good. But though they are highly educated they re not given the job. It s like they re actually not sitting at home, they re going out and trying different jobs So it s hard for us to see our parents work different from what they were (Tamil female participant, 14 years old) 12
Discrimination At the larger systems and societal level, discrimination is a significant stressor for youth It s not only the language; it s also the people, the culture. I felt that I m no one, like an intruder. That oh this is my country and you don t belong here. People are nice but then there s going to be negative people, there s going to be racist people, they re just not open. You get a lot of judgement and sometimes I have comments like oh, let s say I do something bad they re like go back to your country (Colombian female participant, 16 years old) 13
Policy Recommendations Intersectoral approaches to promoting migrant wellbeing Integrated community based mental health services Social determinants Gender and lifestage sensitive Recognize both challenges and resiliencies 14
Policy Recommendations continued Education and training Public education and campaign for migrants Cultural interpreters Health and social service providers and students Remove barriers to economic and social integration Longitudinal and comparative research 15
Acknowledgments The Immigrant Mental Health Policy Brief was funded by the Public Health Agency of Canada and Metropolis Canada (2009). The Immigrant Health in Ontario Policy Report was funded by the Ministry of Health and Long-Term Care (2009). The Newcomer Youth Mental Health Project was funded by the Provincial Centre of Excellence at CHEO (2007-2009). 16
Contact Details Nazilla Khanlou RN, PhD OWHC Chair in Women s Mental Health Research Faculty of Health & Associate Professor, School of Nursing, York University nkhanlou@yorku.ca Tahira Gonsalves, MA Research Coordinator, Office of the OWHC Chair owhchair@yorku.ca 17
References CIC. (2008). Annual Report to Parliament on Immigration, 2008. Available URL: http://www.cic.gc.ca/english/resources/publications/annual-report2008/section4.asp Khanlou, N., Shakya, Y. & Muntaner, C. (2007-2009). CHEO Newcomer Youth Mental Health Study. Funded by the Provincial Centre of Excellence for Child and Youth Mental Health at CHEO. Khanlou, N. (2009a). Immigrant Mental Health. Ottawa: Public Health Agency of Canada and Metropolis Canada. Available URL: http://canada.metropolis.net/pdfs/health%20seminar/khanlou-health%20seminar- EN.pdf Khanlou, N. (2009b). Equity in Health and Human Services Strategic Initiative: Immigrant health in Ontario. Ontario: Health System Planning and Research Branch, Health System Strategy Division of the Ministry of Health and Long-Term Care. Statistics Canada. (2010). Projections of the Diversity of the Canadian Population 2006-2031. Ottawa: Statistics Canada. Catalogue no. 91-551-X. World Health Organization (WHO). (2010). Mental Health: Strengthening mental health promotion. Available URL: http://www.who.int/mediacentre/factsheets/fs220/en/ 18