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7.3.2

Why intersectionality matters

Recognition of intersectionality allows us to appreciate how social identities interact within sociopolitical structures and the effect this has on the settlement and integration of immigrants and refugees. The next case scenario explores this in more detail. Intersectionality helps us recognize that oppressed social status is not merely a product of individual perceptions, attitudes and behaviours; rather, our social identities are also wrapped in complex structures of systemic inequalities and/or privilege (Wilson, White, Jefferson & Danis, 2019).

Intersectionality in clinical interactions

An intersectional lens requires health care providers to confront their biases (e.g., regarding commonalities or differences between the provider and client). This can challenge assumptions and clarify issues that arise between clinicians and clients.

Health care providers must consider a large set of influences that may affect a client's responses to illness and treatment. As providers bring this information to the clinical encounter, it can be useful to identify and acknowledge a client's circumstances and to share this with the client as they collaborate in addressing the mental health problem (Wilson, White, Jefferson & Danis, 2019).

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Imagine this scenario

You see a woman in your practice who, despite living in Canada for many years, has recently lost her refugee status. As a result, she is undocumented in the country. She is a person of colour and suffers from a physical disability, requiring her to walk with a cane.

Despite her health challenges, she has started her own business, which has thrived. She has done very well financially and has a supportive partner and numerous friends and colleagues.

Due to her tenuous immigration status, she is mistrustful of most institutions and has neglected her health for many years. For that reason, she avoided coming to your clinic. She also kept away from the clinic until now because walking was difficult for her and there were stairs at the entrance to the building. Because of deteriorating symptoms, she eventually accessed your services, and although it has taken years, a relationship of trust has developed. Due to her worsening symptoms, she was referred to a specialist to help manage her condition.

After her first appointment with the specialist, she calls your clinic irate. She is furious that you had sent her to the specialist. She described the interaction as “dehumanizing” and is unwilling to return to see the specialist. Upon further exploration, it appears that the specialist made a number of disturbing comments. She was asked why she was in Canada if she didn't have her immigration status. She was told that there was a medication that may help her but that she likely would not be able to afford it. She left the session feeling demoralized and depressed. With time, she has become increasingly angry about the interaction and asks you to address the issue.

Reflection

  1. 1

    What are the areas of intersectionality for this client?

  2. 2

    What individual and interpersonal issues does this situation highlight?

  3. 3

    What are some of the stereotypes that the specialist may have about this client?

  4. 4

    How would you respond to the client's concerns: What issues are involved?

  5. 5

    How could you best intervene to address this situation?

7.3.2

Intersectionality and mental health

Significant intersecting identities and experiences between and within populations affect mental health. In Canada, rates of mental health problems, illnesses and disorders vary significantly between and within different immigrant groups, suggesting important intersections between immigration, race, country of origin, age at arrival, gender, income and mental health (Hyman, 2009; MHCC, 2016). Multiple layers of intersectionality need to be considered, including a person's unique circumstances, aspects of a person's identity, types of discrimination that a person may be subjected to and larger forces and structures that work together to reinforce exclusion.

The diagram below represents these multiple layers of intersecitonality
Intersectionality and Mental Health. S t r u c t u r e s D i s c r i m i n a t i o n I d e n t i t y Circumstances
(Simpson, 2009)

Service providers should acknowledge the intersections that affect the mental health of the service user, as well be aware of the relationship between themselves and the service user, and the social location of both (MHCC, 2016). In addition, it should be acknowledged that people do not fit neatly into one identity, and that service provision, support and treatment should not be generalized (MHCC, 2016).

The intersectional model

The key assumptions of the intersectional model include:

Developing an intersectional approach

Strategies for developing an intersectional approach include:
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Featured resources

The Canadian Research Institute for the Advancement of Women provides several downloadable resources on specific intersections such as women and poverty, race and gender, and a discussion of intersectional feminist frameworks.

NewtoBC: Community Immigrant Demographic Profiles

City for All Women Initiative: Advancing Equity and Inclusion: A Guide for Municipalities (AMSSA 2017).