Breakout #13: Identifying & Responding to Client S Mental Health Issues

RAP Conference Breakout #13: Identifying & Responding to Client’s Mental Health Issues

Wednesday, February 21, 2007

Panelists: Dr. Soma Ganesan - Psychiatrist, VancouverGeneralHospital

Bindu Narula – Calgary Catholic Immigrant Society

Marufa Shinwari – Manager, Settlement and Integration Organization, Hamilton

(PowerPoint available at

SPOs staff are not professionals in this field of mental health yet they encounter it regularly especially in light of the emerging trends in refugee resettlement.

Overview of refugee/immigrant trauma.

Workers need to be aware of background and impact of experiences on specific refugee populations. For example:

Immigration Trauma

Pre-Migration Stress

Refugee CampExperience including protracted situations.

Further aggravated by the post-arrival and resettlement experience.

Culture Shock and which further impacts on their emotional State

The stress of migration which occurs after the honeymoon phase and refugees begin

To realize that their expectations may not be the reality.

Possible Results of Stress and Traumatic Experiences require relevant mental health responses. We need to be able to share cultural profile of groups and research, which compares culture shock, and migration stress on immigrants as compared to asylum seeks with a particular focus on those who are government sponsored.

Responding to Client’s Mental Health Issues

Needs

Sharing of cultural profile for special groups.
Comparative of cultural shock/migration stress on independent immigrant as compared to individuals who are government sponsored.

Promising Interventions approaches.

Focus is on reducing isolation. Many of the GARS who come to Hamilton are women and children.

CMHOP (Children Mental Health Outreach Project) – has been funded by Ministry and Youth Services to address issues experienced by children and youth refugees.

Youth Activities – provided by the HOST program.

•Art Classes / Art Therapy

•Kits Club

•Home work and Dance Club and Movie Night

Women’s Activities

•Cooking Class

•Craft & Sewing Class

Formation of Ethno Specific Communities

•Welcome Circle

Life Coaching & Personal Mentoring (New Project)

RAP Conference Breakout #13: Identifying & Responding to Client’s Mental Health Issues (cont’d)

Wednesday, February 21, 2007

Bindu Narula– Calgary Catholic Immigrant Society(see PowerPoint at

Mental health viewed differently or as a taboo subject across the world. “What is normal behaviour?” Mental Health can be relative – within a cultural context some things are accepted and easily explainable. Need to understand values and behaviour in a cultural context.

Mental Health vs. Mental Well Being

There are degrees of Mental Health. It is not a static state or condition and can change with circumstances. Clients with severe mental illness are few but there are many people living on the fringe, they can go either way - Coping resettlement obstacles with alcoholism, family violence, withdrawal and social isolation - Finding the balance between stereotyping and acknowledging the impact of the refugee’s experience is one that needs attention. Stereotypes about mental health - Both amongst refugees and about refugees it’s important not to make assumptions or to expect everyone to react in the name way to similar experiences. - Most GAR will not admit they are suffering form mental health issues or may not know how to name it.

Mental health vs. mental wellness.

Services provided to all GARs

Primary Counsellor

(RAP & ISP) up to 3 yrs

Follow up and monitoring

HOST program

Dedicated volunteers from community

Survivors of Torture Program – allow refugees to tell their stories – known to reduce affects of such experiences.

Refers clients for appropriate psychological counseling

Calgary Refugee Health Program – located at local assessment house – mental health is assessed. - Referrals to mainstream resources, Psychologists, Hospitals for severe cases

Collaboration

Networking with other agencies and community members

On-going joint meetings with Calgary Refugee Health Clinic, CCIS and CHRA to discuss mental health issues and identify gaps and appropriate resources in the community

Some Gaps Identified:

Staff not trained to recognize symptoms

Lack of sufficient support system-both clinical and informal clients end up falling through the cracks in system

Back home clients with more serious issues would most likely be institutionalized and monitored; here they are left virtually unmonitored

Some resources:

Connecting people with ethno-cultural communities

Cross Cultural Mental Health

CHRA 1st language resource for mental health

Peter Lougheed Centre Crisis Team

Loss Counseling/Grief Counseling thru CRHA

Mental Health Clinician at Alberta Children’s Hospital

References



RAP Conference Breakout #13: Identifying & Responding to Client’s Mental Health Issues (cont’d)

Wednesday, February 21, 2007

Dr. Soma Ganesan - Psychiatrist,VancouverGeneralHospital

(see powerpoint

Challenges:

Many settlement workers are mental health workers
Most Settlement Workers never formally trained in mental health.
Interpreter training for interpreters – not aware of an interpreters being trained in mental health interpretation.
How do we bring the issue to health care? How do we influence the modification of they system.
How do we include the informal mental health services provided by Settlement Workers into the formal system?

Service barriers

Canada’s Health Act guarantees equal access to services but services are not available, or not accessible, and not acceptable. This results in frequent misdiagnosis

Inappropriate use of interpreters and paraprofessionals
Culturally inappropriate treatment methods
Traditional mental health providers impose own values and understanding on populations that they know very little about.

What has been done to influence the key and senior decision makers with respect to the mental health needs of immigrants and refugees? Change in the system needs to happen from within. How do you work with services in your community in a collaborative equal partnership type way? Do not create an ethnospecific system but force to the mainstream to change.

Reference: After the Door Has Been Open – Report on Task Force for Immigrant and Mental Illness.

Important Factors in Planning Collaborative Primary/Mental Health Services for Ethnocultural Population

Appropriate interpretation services
Ongoing training for organizations and front-line staff
Role of community for Immigrant settlement services
Development of cultural competency training curriculum in professional training programs at academic centers
Inclusion of Immigrant agencies in Federal, Provincial and Municipal as partners in service delivery system
Explore role of diversity coordinator in community health centers
No “cook book” model
“Bottom up research” and collaborative research should be encouraged

References:

After the Door Has Been Opened – Report on Task Force for Immigrant and Mental Illness

Kirby Commission Report: Study on the State of the Health Care System in Canada -

RAP Conference Breakout #13: Identifying & Responding to Client’s Mental Health Issues (cont’d)

Wednesday, February 21, 2007

Questions (Q) Responses (R) & Comments (C)

Q. Have there been any study on rudimentary illness in refugees.

R. Kirby and Romano reports have both recommended that every level of government and mental health services address the need for resources for health money promotion – The questions is “What is the role of settlement services in the areas of mental health promotion?”. Need for community education by settlement services to assist mental health services in better understanding and responding to the needs of refugees and immigrants.

Q. When we do have a severe case and can’t access the health system – as a service provider what should we be doing when you can’t get the support from the system?

R. Need to influence the change of the services.

Q. What about when there are no champions. 25% of Psychiatrist in Canada are trained in a country other than Canada – what are they doing?

C. When people are having severe problems but they only have us and constantly come to us maybe everyday they are on the premises. Can the RAP Working Group facilitate a discussion across the country about these issues? – Network of interested individuals who can begin to think about these issues.

Q. According to my experience you can sometimes see the symptoms i.e. someone who is constantly in conflict with everyone but the person refuses to get help, how do you help such a person?

R. Nothing you can do if someone refuses to go for help. Sometimes sharing the experience with someone from the same group is very scary. People need to take responsibly for themselves and workers need to be clear about boundaries.

National RAP Conference (Feb.19-23, 2007 – Vancouver B.C.)