About the Immigrant and Refugee Mental Health Project (IRMHP)

The IRMHP is a training and capacity-building project funded by Immigration, Refugees and Citizenship Canada. It provides online training, tools and resources to settlement, social and health service providers across Canada to support their work with newly-arrived immigrants and refugees.

 

The IRMHP encourages individuals to participate in the project by:

1.       adding your name to our course sign-up list. we will notify you once course registration is open, as spots are limited. The Immigrant and Refugee Mental Health online course is a free, self-directed, interactive training providing an overview of immigrant and refugee mental health. It provides sample tools, evidence-based strategies and interventions, and innovative practices from across Canada to help offer appropriate services and supports to newcomer client populations. The course will launch fall 2018.

2.       joining the IRMHP community of practice (CoP) discussion board or subscribe to the IRMHP newsletter. These virtual communities allow you to stay up-to-date on events and resources in the sector, network with service providers across Canada, and share promising practices.

3.      participating in the IRMHP monthly webinars, which are open to anyone working with newcomers. They are on a range of topics based on the needs and interests identified by service providers, and offer practical and actionable strategies or resources to support or treat the mental health needs of immigrants and refugees.

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What’s So Special about Canada? Understanding the Resilience of Immigration and Multiculturalism | migrationpolicy.org

Canada has in recent decades occupied a privileged place among the world’s top immigrant-receiving countries. Despite weathering many of the same economic and political challenges that have buffeted support for immigration in other countries—from recession to threats of terrorism—Canada has managed to maintain a consistently positive public consensus around its immigration system.

While Canada has a long history of immigration, since the 1980s policies governing new arrivals have, to a large degree, been tied to demographic and economic considerations. Permanent residents admitted for economic reasons comprised roughly 60 percent of all admissions to Canada over the past five years. Polls suggest that this is in line with public preferences: in a 2011 survey, for example, 69 percent of Canadians thought immigration policy should prioritize nationally relevant education and skills. Canada’s geographic isolation from global conflicts or extreme poverty has safeguarded its selection system from mass arrivals or large-scale unauthorized flows. Furthermore, the diversity of immigrant arrivals to Canada—in  2014, new permanent residents came from nearly 200 countries—has ensured that any conception of “the immigrant” is not reduced to one ethnic, racial, or religious identity.

Canadian attitudes sympathetic to immigration and globalized cultural diversity took time—and, arguably, political will—to develop. This Transatlantic Council on Migration report explores the evolution of Canada’s apparently unique attitude toward immigration and diversity by presenting a snapshot of the country’s public opinion polling on immigration, and discussing the matrix of social policies, institutions, and institutional practices that have driven this positive consensus.

Source: What’s So Special about Canada? Understanding the Resilience of Immigration and Multiculturalism | migrationpolicy.org

Health considerations in the Syrian refugee resettlement process in Canada

Abstract

Canada has responded to the humanitarian emergency in Syria by committing to welcome 25,000 Syrian refugees by early 2016. This has been a complex undertaking which required coordination between international organizations, such as the United Nations High Commissioner for Refugees (UNHCR), the International Organization for Migration (IOM) and federal government departments, including Immigration, Refugees and Citizenship Canada (IRCC), the Canada Border Services Agency (CBSA), the Department of National Defence (DND) and the Public Health Agency of Canada (PHAC). Within and across Canada, this initiative has also required the collaboration of provincial and municipal governments, non-governmental organizations and volunteers, including private sponsors, to enable planning for the transition of Syrian refugees into a new life in Canada.

In planning for the reception of Syrian refugees, government agencies did not anticipate major infectious disease threats. However, early findings from Europe and the experience of health care providers who serve other refugee populations suggested that this population may have other unmet health needs and untreated conditions, due to their experience of displacement over the past three to four years. With this in mind, a great deal of planning has been undertaken to address potential challenges to public health. Social services providers and medical interpreters have been enlisted to help Syrians access the health care system and explain their needs. Communities of practice within Canada have responded, both in providing care and in developing and updating tools and resources to support a culturally sensitive and evidence-based approach to screening and meeting the health needs of the Syrian refugees.  Read Article

The European Psychiatric Association Guidelines on Cultural Competency – Summary

The European Psychiatric Association Guidelines on Cultural Competency

EPA guidance on cultural competence training. Schouler-Ocak, M., Graef-Calliess, I. T., Tarricone, I., Qureshi, A., Kastrup, M. C., & Bhugra, D. (2015). European Psychiatry, 30(3), 431-440. doi:10.1016/j.eurpsy.2015.01.012

 

What is Cultural Competency?

  • Cultural Competency as a skillset “that a clinician can employ to understand the cultural values, attitudes and behaviors of patients, especially those whose cultural background differs from that of the mental health professional”
  • Cultural Competence includes an awareness of the impact of the psychiatrists’ own ethno-cultural identity on their patients
  • Cultural Competence is a concept that captures the capacity to provide appropriate care for diverse patients, overcoming socio-cultural differences and other systemic challenges to reduce disparities with regard to mental health care provision
  • Cultural Competency is about respecting differences and making sure that these are bridgeable in order that they do not negatively impact upon the diagnostic and therapeutic process

 

Why is Cultural Competency needed?

  • Cultural Competence is necessary in clinical practice whereby the psychiatrist sees each patient in the context of the patient’s culture as well as their own cultural values and prejudices
  • mental health specialists regularly come into contact with patients from different cultural backgrounds
  • immigrants’ health, including mental health, is seriously affected by their trajectory and/or the social conditions in which they live in the receiving country
  • the ability to understand and be aware of cultural factors in the therapeutic interaction between the therapist and the patient
  • culture plays an important role in the symptom presentation of distress and illness
  • idiom of distress in which patients communicate with psychiatrists can vary considerably from culture to culture and many languages do not have equivalent words to describe various mental disorders
  • minority patients are not the only ones who have differing cultures. All patients and staff are shaped by their own cultures with respect to ethnicity, religion, professional world etc., which can be very different from those of the patients.
  • patients are not the only ones with culture. institutions have their own cultures as well which can produce barriers of various kinds, and minority groups may well face strong barriers to health care access
  • patients who are illegal or undocumented immigrants, asylum seekers, or refugees have a “fragile existence” which raises additional issues about clinical management best addressed by culturally competent therapists.

 

How does Cultural Competence play out in clinical management?

These are some of the culturally adapted interventions suggested:

  • the cultural values of the immigrant patient should be incorporated into therapy
  • if possible immigrant patients can be paired with therapists of the same cultural or ethnic group
  • mental health interventions should be easily accessible and targeted to immigrant patients’ circumstances
  • support resources available within an immigrant patient’s community, extended family members, and tradition should all be incorporated into therapy interventions
  • Interventions conducted in patients’ native or primary language
  • the incorporation of psychologically trained interpreters or culture broker into the treatment process
  • review the cultural formulation interview in DSM-5 in which a major effort was made to recognize the influence of cultural factors on psychiatric symptoms and disease entities

 

What are the benefits of Cultural Competency?

  • culturally knowledgeable therapists influence changes in attitudes and behaviors in patients
  • therapists who show multicultural competence receive higher ratings than therapists who do not show multicultural competence
  • Cultural Competence training presented to psychiatrists in the context of clinical practice and with organizational support can lead to progress made in decreasing ethnic disparities in care

 

What are some suggested methods of developing Cultural Competency?

  • using cases and case note reviews
  • participant observation
  • cultural consultation where members of staff present cases and experts can advise them on specific cultural issues
  • Interactive lectures and role play along with small group work can help staff understand the most effective ways of doing things and engaging patients
  • listening carefully to the patient
  • eliciting the psychopathology in a culturally appropriate manner
  • assessing needs and suggesting changes in management while looking at the outcome
  • therapist acknowledging their own personal prejudices and try and deal with them
  • avoiding assumptions and stereotyping to develop higher levels of empathy will produce better therapeutic engagement
  • cultural empathy can transcend language barriers as most of the communication occurs at a nonverbal level
  • Outcome indicators may be one way forward for measuring cultural sensitivity and Cultural Competency in an organization

 

In conclusion:

“Competent treatment of minority patients requires that mental health professionals are open to understanding the similarities and differences between more traditional and modern Western approaches. It is important to understand and emphasize that Cultural Competence is not a static phenomenon but a developmental process, which represents a continuum. It must be remembered that Cultural Competency should be tempered with what has been termed ‘‘cultural humility. Attaining a level of cultural proficiency indicates a level of Cultural Competence but this is not absolute and will need ongoing development.” And “individual learning is not enough to guarantee a sensitive approach to diversity at the organizational level”, “institutional Cultural Competence requires not only the recognition of the barriers that exist to quality care at a systemic, organizational, and institutional level but also the elimination of these”.

 

Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians

A Review for Mental Health and Psychosocial Support Staff Working with Syrians Affected by Armed Conflict

This report, prepared for UNHCR in 2015, provides information on the sociocultural background of the Syrian population as well as cultural aspects of mental health and psychosocial wellbeing relevant to care and support. it is based on an extensive review of the available literature on mental health and psychosocial support, within the context of the current armed conflict in Syria.

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