Refugee mental health & providing effective support Presenter: Maria Lo November 8, 2016
Identify the social factors that impact on individuals health Review the role of service providers in improving the holistic health status of their clients Explain the causes of mental health challenges of refugees/immigrants using social determinants of health framework Motivate clients to seek support (professional/caregiver) through active engagement skills 2
The World Health Organization (WHO) constitution (1948) states: Health is a state of complete physical, mental and social well-being and not merely the absence of Disease or Infirmity. resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. (WHO,1986) 3
WHO defines Mental Health: a state of well-being in which every 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 her or his community. 4
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Factors that affect the mental health of immigrants and refugees which are beyond individual s control: (Social determinants of health) Income and social status Education Employment / Working conditions Social environments Physical environment Healthy child development Social support network Source: The Public Health Agency of Canada 7
Adapting to a new culture Learning new language Coping with losses, i.e. family and social supports, Experiences of trauma before and after settlement Coping with discrimination Establishing the support network Unemployment and underemployment Changes in the socioeconomic status Seeking for culturally appropriate mental health care practices
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Statement #1 If I don`t have mental illness, I`m not affected by it. True or False 10
FALSE Mental illness strikes 1 out of 5 Canadians All Canadians are affected by mental health issues or mental illness 11
Statement #2 Mental health factors, such as stress, anxiety, and depression, don't affect your overall health as much as physical factors. True or False 12
FALSE Your state of mind is connected to and shapes all other bodily states, and needs equal attention. Excess stress increases the release of the stress hormone cortisol, which can further increase blood sugar and accelerate progression to diabetes. This illustrates stress can directly affect your physical health. Source:Mental Health Myths in South Asians http://www.pamf.org/southasian/risk/concerns/mentalhealthmyths.html 13
Everyone has attitudes and judgments that affect how we think about and behave toward others Stigma refers to negative, unfavourable attitudes and the behaviour they produce. It is a form of prejudice that spreads fear and misinformation, labels individuals and perpetuates stereotypes. Source: www.mentalhealthcommission.ca/english/pages/openingminds.aspx 14
Stigma: prejudice and discrimination towards people with mental illness misconceptions discomfort with differences fearing and avoiding what we don t understand Many people living with a mental illness say the stigma they face is often worse than the illness itself. 15
Intertwined with and just as important as physical health finding a balance in all aspects of your life Finding a balance is a unique learning process 16
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Biological Environmental Genetic Predisposing Factors Mental Health Precipitating Factors -Loss -Migration -War -Trauma Decreased health status Inadequate housing Inadequate income Social exclusion Stress Unemployment Perpetuating Factors Physical & Spiritual Health Protective Factors Source: Wong, J. P. (June 2006). Intersecting sexuality, gender, race & citizenship: Access to adequate income, housing, employment, etc. Community support Coping ability Personal strengths Social inclusion Social support 18
In any given year, one in five people in Canada experiences a mental health problem or illness, with a cost to the economy of well in excess of $50 billion Source: Mental Health Commission of Canada. (2012). Changing directions, changing lives: The mental health strategy for Canada. Calgary, AB: Author. 19
(not a check list or an exhaustive list) Physical symptom s Restlessn ess Insomnia Weight gain or loss Anger Poor concentra tion Panic attacks Loss of appetite Crying easily Feelings of sadness Loss of interest or motivation in daily Changes activitiesin relationships with family members or peers Does not automatically mean we have mental illness 20
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An anxiety disorder Produced by an extraordinarily stressful event Re-experiencing of this event through flashbacks and nightmares 2-5% of population 30% of veteran involved in war Male to female ratio: 1:2 Age of onset: any age, including childhood 22
What are the Symptoms? Difficulty falling or staying asleep Unwanted thoughts, memories, images or dreams about the event Acting and feeling as if the traumatic event is happening again Extreme vigilance feeling watchful all the time and being easily startled Extreme distress when something reminds the person of the event 23
Learn about mental health in the context of holistic health Understand associated factors and taking early steps to change Practicing mental fitness Assessment & early treatment Exploring strategies in promoting mental health & coping with stress Organizational & systemic changes beyond the individual level 24
Medical Psychiatric Medication Electroconvulsive Therapy Psychotherapy Psychosocial Group Day Program ACTT Vocational program Psychosocial Peer Support Case Management Alternative Treatment Other community support As unique and individual that mental health issues and addictions are to each patient/client, so too are their assessment and treatment needs. -CAMH 25
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In general, immigrants and refugees are less likely than their Canadian-born counterparts to seek out or be referred to mental health services, even when they experience comparable levels of distress. (Chen AW, Kazanjian A., 2011) 27
the Holistic Health Framework: Significance of Access to Resources 28
Cultural inclusive goes beyond linguistic competence and sharing the same country of origin Presumptions, stereotypes, and playing the expert role can pose barriers to being culturally competent Significance of culture as defined & perceived by the individual Culture impacts on perception of mental health & mental illness Stigma & its impact on help seeking behavior It provides a culturally safe environment Resource & Service Accessibility 29
It is culturally relevant Address the social determinants Equitable access to services and programs Responsive to the needs of the clients groups Reflecting the diversity of the community that being served 30
CONNECTION BEFORE SOLUTION EMPATHY BEFORE EDUCATION Source: Supporting Immigrants and Refugees in Distress Using Tools from the Compassionate Communication Process by Mr. Henry Wai, NVC trainer
Unemployment Poverty Social isolation Shame/guilt Racism and discrimination Language skills.¹ Lack of mobility Inability to take time away from work Concern that problems will not be understood by practitioners because of cultural or linguistic differences. ² 1. Sidher, 2011 2. Whitley R, Kirmayer LJ, Groleau D., 2006 32
Engaging clients Early identification skills, assessment High-quality customer service provider 33
I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. Maya Angelou, author, poet, and activist
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Focus attention on the speaker. A good active listener: is attentive concentrates on the client does not interrupt gives nonverbal feedback (e.g., nodding, smiling, saying "mmm") reflects and acknowledges feelings (e.g., "You sound very happy today.") summarizes the main points back to the speaker asks for clarification when needed, using open-ended questions always asks questions in a non-judgmental way, using a tone of voice that expresses interest and concern. CAMH, 2012 36
A peer support worker said, A smile can solve a thousand problems.
A section of the DSM recognizes that everyone has a culture and the following factors should always be considered when working with clients: 1. Cultural identity 2. Cultural explanations of illness 3. Cultural practices regarding to psycho-social practices 4. Cultural elements between patient and health care provider. 5. Cultural assessment and care plan. Dr. Kenneth Fung, 2013 38
How people explain the causes of illnesses. Ask to find out someone s personal explanatory model of illness: What do you call the illness? Why does it exist/what caused it? Who should treat it? What treatment is needed? The point to remember is that people can have the same illness, but experience it differently from each other. Dr. Kenneth Fung, 2013 39
Relating & Responding to Client: -Listening -Verbal & non-verbal communication (e.g. body language, ) -Recognition & support V.s. Judging & Reasoning Alternatives: - What s Workable V.s. What s not Workable - Strengths V.s. Problems - Hope V.s. Giving Up
Keep a needs-based focus. Maintain confidentiality and safety. Help empower clients. Respect clients' self-determination and personal freedom. Keep expectations realistic. CAMH 42
Working on Client s positives & strengths v.s. fixating on problems that do not have immediate solutions Setting contract & boundary with the client through a trusting & supportive relationship: Without trust, setting limits can turn into a power struggle With trust, rapport & listening, we can support client to enhance coping & social skills as well as possibly working towards getting other types of support & treatment (e.g. psychiatric treatment, mental health support services) 43
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Facilitate the initial interviews to occur e.g. reminder; transportation; interpretation Provide support Provide information Dr. Kenneth Fung, 2013 45
Collaboratively identify the need and the most appropriate consultant(s) or service(s) and offer choice Clarify and implement the correct referral procedures Preparation for the consultation / services intake Who and what to bring? What to expect? Any barriers to going? 46
Follow-up with the client Follow-up on the consultant / services Facilitate next steps Circle of care/consent 47
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