Impacts of Mental Health on Immigrants

Introduction

Canada is recognized and celebrated as one of the world's most multicultural countries. However, what lurks beneath the surface is a growing problem known as a lack of mental health supports for immigrants, particularly those that are facing significant language or cultural barriers. This is particularly troublesome as immigrants and refugees are those that make up a dominant percentage of the country’s population, and the well-being of these individuals can have a potentially debilitating impact on Canada’s economy and status as a influential world-player, to say the least. The World Health Organization (WHO) defines mental health as a state of well-being in which the individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her own community. For many of these immigrants, particularly those of Asian descent, they may be facing large amounts of stigma in relation to mental health that presents them with barriers to access and care, in addition to the obstacles mentioned above. Although there has been much progress to destigmatize mental illnesses, particularly as of recently, for those immigrants that are more mature or elderly, the progress may not be registering with them as well as the younger population. As mental health is extremely complex and mental illnesses do not result from any one risk factor or outcome, it is important to be able to understand the myriad of ways that it can have an impact on an immigrant’s ability to adjust well to life in Canada.

Understanding the Immigrant Journey

The process of immigration and settlement in itself is inherently stressful, particularly for those that are first-generation. Immigration is a profoundly non-normative life transition requiring extensive adaptation. In the best case scenarios, immigrants, such as family units, are pulled to migrate to Canada due to a desire to provide exposure to diversity in terms of culture and language to their children. However, in the worst case scenarios, immigrants and refugees may be seeking asylum or otherwise having to consider the move as a last resort. In regards to mental health, this is especially troubling as this leaves these individuals most susceptible to developing PTSD, or other related issues. Migrant groups have over twice the risk of schizophrenia compared to non-migrant groups and the rates of psychological distress… are markedly raised in refugees. As a whole, there are clear pressures [that] cannot be considered normal life stresses. Mental health of immigrants “might be undermined by their acculturative stress, in the course of uprooting, relocation, and adaptation, due to adjustment challenges.

History

Over 200 different languages are spoken in Canada, and 20% of Canadians have a non-official language as their mother tongue. Despite this, there has been limited Canadian research on the mental health of immigrants, even given that mental health of immigrants and refugees becomes a concern primarily when additional risk factors combine with the stress of migration. However, data has shown that females were more likely to report experiencing emotional problems, and immigrants from North America and all Europe were less likely to rate most days as very or extremely stressful than immigrants from Asia and Pacific. In 2012, the Mental Health Commission of Canada released its first-ever mental health strategy for Canada, with five recommendations targeted at improving immigrant and refugee mental health.

Impact of Discrimination

There is a definite relationship between perceived discrimination and depressive symptoms for migrants. Though Canada may be able to present itself as a country that experiences very little racism, the reality is that for new immigrants that are unable to integrate into society as well as others, they can be subject to the highest amounts of racist or otherwise derogatory remarks. In 2005, a study found that participants who identified closely with their heritage culture were at an increased risk for suicidal thought but not for suicidal plan or attempts. Therefore, it is imperative that immigrants be given access to a robust support system in the form of communities or possibly ethnic enclaves. According to the World Health Organization, depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance use affect women to a greater extent than men across different countries and different setting, Further, family conflict has been found to be a risk factor for a number of psychiatric disorders among immigrants while family cohesion has generally been found to be a protective factor. Understanding of how immigrants perceive the attitudes of persons in the social milieu where they live and work and how these attitudes impact policy and consequently the mental health of immigrants is paramount. Even in the workplace itself, Statistics Canada reports that “immigrants fare less well at work than people born in Canada despite their qualifications”. They face discrimination not only in their everyday lives, but also in the workplace, where unemployment is not only more common for immigrants but even more so for immigrants who are racialized, and some argue in Canada that there is a color to poverty.

Influence on Healthcare

The most common barrier to accessing healthcare is language. However, they are not simply a challenge of communicating specific information but rather impact both instrumental and emotional aspects of the patient-provider encounter. An inability to communicate in the dominant language has been posited to influence health outcomes by producing social isolation, insecurity, lack of access to relevant information… which in turn impacts self-esteem and position within family and other social systems. In fact, there could be low rates of mental illnesses in immigrant groups when they arrive in Canada, [but these] may increase over time. Aside from language, immigrants whose host culture may be rooted in what Canada may consider to be untraditional, such as faith or ritual-based healing beliefs, a further unfamiliarity with the Canadian medical system may lead to barriers to access. As severe mental health illnesses require professional diagnoses and treatment, immigrants are at a further disadvantage than their counterparts. Furthermore, a medical system that is without culturally sensitive care may create additional challenges, and can result in death of patients due to lack of understanding or even malpractice. According to the Canadian Mental Health Association, although mental illnesses may present themselves with similar symptoms across the world, “their manifestations and how people describe and interpret symptoms vary with ethnicity and culture”. Therefore, one size fits all services ignore the differential needs, presentation of problems and desires of groups and could lead to poorer outcomes.