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Course page How to navigate the course Course syllabus Glossary Course intro Details and logistics CoP SMEs Course agreements and conditions Acknowledgements

Module 1: Immigration and social determinants of health
1.1 — Understanding mental health in Canada
1.1.1. General prevalence and impact + 1.1.2 Legislation affecting the rights of clients
1.2 — Understanding immigration in Canada
1.2.1 A brief history + + 1.2.2 Temporary Residents 1.2.3 Permanent Residents + + 1.2.4 Immigration Trends + 1.2.5 Demographic trends + + + +
1.3 — Mental health of immigrants and refugees
1.3.1 Immigrant and Refugee Mental Health 1.3.2 The healthy immigrant effect 1.3.3 The determinants of mental health + 1.3.4 The migration journey 1.3.5 Social determinants in the post-migration context + + +
Case study: Ibraheem Summary

Module 2: Intro to Mental Health
2.1 Understanding mental illness
2.1.1 Understanding mental health and mental illness 2.1.2 The continuum of mental health and mental illness 2.1.3 Prevalence of mental health problems and illness among immigrants and refugees
2.2 Common mental disorders
2.2.1 Depressive disorders 2.2.2 Anxiety disorders 2.2.3 Posttraumatic stress disorder + 2.2.4 Psychosis 2.2.5 Substance abuse
Summary

Module 3: Key populations - women
3.1.1 Social risk factors affecting women 3.1.2 Gender-based violence + + 3.1.3 Pregnancy + 3.1.4 Barriers to seeking help 3.1.5 Clinical considerations 3.1.6 Providing mental health support + Summary

Module 4: Key populations - children
4.1.1 Immigrant and refugee children 4.1.2 Needs of adolescents and youth 4.1.3 Mental illness and mental health problems + + 4.1.4 Needs of adolescents and youth 4.1.5 Post-migration and social determinants of mental health 4.1.6 Risk and protective factors + + 4.1.7 Distress vs. mental disorder in refugee children + 4.1.8 Providing mental health support + + Summary

Module 5: Key populations...
5.1 Older adults
5.1.1 Older adults 5.1.2 Risk factors for mental health problems and illnesses 5.1.3 Clinical considerations 5.1.4 Promoting mental health
5.2 Survivors of torture
5.2.1 Survivors of torture 5.2.2 Effects of torture 5.2.3 Clinical considerations + + 5.2.4 Mental health interventions +
5.3 LGBTQ2+ immigrants and refugees
5.3.1 LGBTQ2+ immigrants and refugees 5.3.2 Risk factors for mental health 5.3.3 Clinical considerations 5.3.4 Mental health interventions
5.4 People living with disabilities
5.4.1 People living with disabilities 5.4.2 Risk factors 5.4.3 Clinical considerations 5.4.4 Providing mental health support
Summary

Module 6: Treatment and support
6.1 Treatment
6.1.1 Treatment 6.1.2 Providing newcomers with mental health services 6.1.3 Treatment models 6.1.4 Cultural competence in mental health care 6.1.5 Trauma-informed care 6.1.6 Resilience
6.2 Treatment interventions
6.2.1 Treatment interventions 6.2.2 Psychosocial interventions
6.3 Psychotherapy and counselling
6.3.1 Psychotherapy and counselling 6.3.2 Cultural factors 6.3.3 Psychotherapeutic interventions
6.4 Pharmacotherapy
6.4.1 Pharmacotherapy 6.4.2 Cultural factors 6.4.3 Practical issues
Summary

Module 7
7.1 Health equity
7.1.1 Health equity 7.1.2 Why health equity matters
7.2 Anti-Racism
7.2.1 Racism 7.2.2 Anti-Black racism 7.2.3 Racism and mental health + 7.2.4 Social inclusion and exclusion 7.2.5 Bias + + (SW) + (HP) + (SW) + (HP) Anti-oppression framework (SW) + (SW)
7.3 Intersectionality
7.3.1 Intersecting identities 7.3.2 Intersectionality and mental health (HP) 7.3.2 Intersectionality and mental health (SW)
7.4 Anti-oppression and allyship
7.4.1 Inclusive practice and how to work inclusively 7.4.2 Moving from cultural awareness to cultural humility + (HP) 7.4.2 The process of unlearning 7.4.4 Power and privilege +
Summary

Module 8: Service delivery + pathways to care
8.1 Pathways to Care
8.1.1 Navigating mental health services + 8.1.2 Factors that influence help-seeking + 8.1.3 Connecting with primary care
8.2 Facilitating effective service use
8.2.1 Facilitating effective service use 8.2.2 Make changes to programs, policies and institutions 8.2.3 Consider the impact of culture +
8.3 Working with interpreters
8.3.1 Language and its effects on access to care 8.3.2 Translation and interpreting + + + 8.3.3 Types of interpreters 8.3.4 Mental Health Interpretation +
Summary

Module 9: Partnerships + mental health promotion
9.1 Strategies for promoting mental health
Strategies for promoting mental health + +
9.2 Social Supports
9.2.1 Social Supports 9.2.2 Formal organizations 9.2.3 Informal social networks +
9.3 Community development and partnerships
9.3.1 Community development and partnerships 9.3.2 Asset-based community development + 9.3.3 Community partnerships + + +
Summary

Module 10: Self-care
10.1.1 Self-care 10.1.2 Compassion fatigue 10.1.3 Secondary trauma 10.1.4 Burnout and its effects + 10.1.5 Boundary issues + 10.1.6 Seeking help +
Summary Glossary
5.1.4

Promoting mental health

The Mental Health Commission of Canada (MHCC) has identified both older adults and diverse (immigrants, refugees, ethnocultural and racialized) communities as strategic priority populations that require greater attention for promotion of mental health and the prevention of mental illness (MHCC, 2012). The MHCC calls for promotion of mental health across the lifespan and recommends actions on countering ageism, promoting active participation, fostering meaningful relationships and maintaining good physical health (MacCourt et al., 2011; MHCC, 2012).

A key to this focus on promoting mental health and preventing mental health problems and illnesses is a service delivery model that supports an integrated mental health system.

This type of system would include the following values:
(MacCourt et al., 2011)

Providers should translate these principles into concrete action and apply them with consideration of language and cultural factors. An integrated system of care consists of a full range of health, mental health and social services to meet the needs of older adults. These services should include establishing and maintaining contact with people from similar and different cultural backgrounds and religious affiliations, and being aware of recreational opportunities and other activities to stimulate older adults mentally, physically and socially (Mental Health Commission of Canada, 2021) (Mental Health Commission of Canada with Tourigny-Rivard, M-F, 2019; MacCourt et al., 2011).

Flexibility in service delivery and recognition of the central role of family and community are the best approaches to meet the needs of this population (Refugee Health Research Centre, 2005). It is important to take into consideration what older clients prefer and, if desired, involve their family as a way to build rapport with the client.

Video: Supporting older newcomers

With Baldev Mutta (CEO, Punjabi Community Health Services)

Where do newcomer seniors fit in? So at Punjabi Community Health Services, we identified two types of seniors. One type of seniors come from the rural background of the Indian subcontinent. And their needs, their wishes, their likes, their dislikes are totally different. Then we have another set of seniors who are very well educated, who were senior level bureaucrats in the Indian subcontinent. Their likes, dislikes and their preferences are totally different. And we at Punjabi Community Health Services recognize that those who are very well educated want to contribute to Canadian society. We have to tailor-make programs for them. So we created programs for the seniors who are very well educated, who want to mentor others, who want to go into schools and read stories to the children. And then there are those who just want to sit down and contemplate as to how their life was. That's a different program. So I think that within the seniors' community, especially within the settlement, I think it's very important to look at how can seniors' cafés be created. How can we have seniors develop programs based on their preferences and their needs? It's not just one set of programming fits everyone. I think those are some unique perspectives on the settlement processes in Canada as well that we need to take into account.

Health service providers should encourage immigrant and refugee older adults to participate in recreational or community events, as well as in as many meaningful social activities as possible. Because religion is a crucial factor in maintaining a sense of community, continuity and stability for many older immigrants and refugees, places of worship are often important sources of support for this group, providing a sense of belonging (Refugee Health Research Centre, 2005).

Older immigrants and refugees who are new to Canada are more likely to report high levels of loneliness than other generations of Canadians (Wu & Penning, 2015). Getting them involved in religious gatherings and senior centres that offer activities such as employment or volunteering, arts and crafts, woodworking, cards and other social outings can help build social networks and reduce isolation.

When possible, provide older immigrants and refugees with information and knowledge about alternative transportation to reduce isolation and promote greater independence. In some communities these are available at a low or no cost, however the information may not be available or well-known among these populations.

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Resources for alternative transportation:

click Ontario: 2-1-1 (or dial 2-1-1) click British Columbia: Seniors on the Move click Alberta: Transportation Alternatives for Alberta Seniors

Review question

True or false?

Opportunities to establish and maintain contact with people from similar cultural backgrounds who share their values and speak their language is critical to promoting mental health among older refugees.

True