The best treatment involves a sensitive and careful assessment based on the client's strengths. This may include discussion with family members as well as the use of interpreters. Health service providers may need to find out more about the client's culture and how it may affect the assessment and treatment. For example, how does the client understand the cause of their illness? The illness model that the client describes not only identifies how they believe they became ill, but also provides valuable insight for the provider looking to customize a treatment plan that the client can successfully adhere to.
A number of different models of care are available that can support clients with mental illnesses. The optimal approach is to find one or a combination that the service provider and their client are comfortable with and that meet the needs of the client.
Refugees, and in some cases immigrants, will have suffered trauma in their past. Clinicians may make a diagnosis of post-traumatic stress disorder (PTSD) or depression based solely on that history, even if the individual is not particularly symptomatic and remains functional. In reality, most refugees will not develop a diagnosed mental health problem (MHCC, 2016b).
Though rates vary significantly among immigrant groups, immigrants generally have lower rates of depression than the general population. With a longer stay in Canada, the rate tends to match that of the general population (Vang et al., 2015; Ng & Zhang, 2020). Longitudinal research suggests that levels of distress may increase for some groups more than others (Pahwa et al., 2012). As with refugee populations, mental distress and symptoms of distress in immigrants do not always translate into a diagnosed mental health problem.
At times, health care providers may not properly consider pre- and post-migratory stressors the individual may be dealing with, which can lead to inaccurate diagnoses. These normal responses to stressful situations are then over-pathologized (Edge & Newbold, 2013). In addition, health care providers may not take into consideration the resilience of their clients. Under-diagnosis can also be a significant problem that can lead to a situation where necessary treatment is not provided. In order to avoid any of these outcomes, health care providers should use a needs-based approach.
We recognize that there is over-psychiatrization, overmedication, over-diagnosis of people who are of racialized bodies. So we're mindful that there are other things that impact a person's life. We bring a holistic lens to those interactions. We recognize that a person may be impacted by environmental, societal, historical things in their lives, any number of things that may be a factor in affecting their health and mental health. If we have somebody who comes to us, for example, and they say, “I'm experiencing headaches, I'm experiencing insomnia, feeling sad.” We won't run to the DSM or to the psychiatrist asking “What do you think this is?” We'll probably have a conversation with them to really understand where this is coming from. It may turn out that this person was a boy soldier. They were separated from their family. The traumatic events in their lives are what's triggering the headaches and the insomnia. So once we understand, we realize that we don't want to label immediately. We want to be really cognizant of what the other factors in the person's life might be that are creating those symptoms that we are seeing. That said, we don't disregard psychiatry. We feel that there is a place for psychiatry in the overall framework of Across Boundaries. We want to be mindful of how we use psychiatry in our services. So we work with racialized psychiatrists, psychiatrists who have their own lived experiences of racism. Psychiatrists who come to us with the knowledge and understanding of anti-racism, anti-oppressive practices that are able to incorporate those in their interactions with our service users.
It is important that pre-migration, migration and post-migration stressors are considered to avoid over-pathologizing normal responses to stressful situations.
Mental distress does not always translate into a diagnosed mental health problem.