Immigrants and refugees : Two realities

Nearly 20% of the Canadian population is foreign-born. Every year Canada welcomes approximately 250,000 migrants, 10% of whom are refugees. Providing quality health care to immigrants and refugees requires recognition of the unique factors that affect their mental health.

Immigrants tend to be healthier than the general population when they first arrive in Canada. However, over the years their level of health drops to the Canadian average. This occurrence among immigrants (not refugees) is linked to the selection process. The point-based system favours people who are relatively well-equipped for life in Canada. Those who are accepted for immigration are proficient in at least one official language, have an education that matches the demands of the job market, and are physically healthy.

Refugees may suffer from worse health because of the violence they have experienced that forced them to seek asylum. They may also have endured great hardship during their flight to safety. Even after finding haven in Canada, they may continue to suffer from after-effects of trauma and loss, and may also fear for the safety of family members left behind.

For both immigrants and refugees, the process of resettlement can be challenging and stressful. Migration involves a disruption of social networks and ties as well as a transition from one socio-economic system and culture to another—changes that require effective coping mechanisms. Upon arrival, immigrants often face under- or unemployment, loss of social status, uncertainty about the future, racism, and discrimination. Children from migrant families may suffer from disruption in their schooling, separation from family members and peers, and difficulties integrating into a new social environment.

Access to mental health services is difficult for people who are not proficient in English or French. Many immigrants use English or French effectively in day-to-day situations, but mental health care requires a higher level of comfort to adequately describe social predicaments and emotional states, and to fully understand recommendations made by clinicians. While both clinicians and patients may feel uncomfortable using an interpreter, professional medical interpreters may be the single most important resource to ensure access to, and quality of, mental health services.

Providing mental health care for migrants requires an understanding of how culture affects mental health. Culture influences many aspects of mental illness and coping, including how people interpret and explain their symptoms, how they cope with or manage distress, the type of help or treatments they prefer and seek out, and how they view their relationship with care providers.

It is essential to understand the specific stressors associated with migration to develop a more accessible and culturally responsive approach that will help migrants benefit from adequate mental health care.