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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
7.4.2

Moving from cultural awareness to cultural humility

In order to offer equitable service to people from different cultural backgrounds and to be accountable for how these services are delivered, it is important that health care providers move from cultural awareness to cultural humility. The pathway from awareness to humility is called the cultural spectrum, which individuals and organizations can follow (First Nations Health Managers Association and Canadian Foundation for Healthcare Improvement, n.d).

At the beginning of the spectrum is cultural awareness, where differences are acknowledged, but there are no active attempts to change behaviour. At the other end is cultural humility, where providers engage in reflective practice to ensure they are creating and building meaningful and respectful relationships based on mutual trust and understanding (First Nations Health Managers Association and Canadian Foundation for Healthcare Improvement, n.d.).

Below is an explanation of the terms along the spectrum.

The cultural spectrum

  • ● ○ ○ ○

    Cultural awareness

    • Acknowledges differences
    • Doesn't seek broader context or understanding
    • Very limited behaviour change

  • ● ● ○ ○

    Cultural sensitivity

    • Acknowledges different ways of seeing the world
    • Integrates some changes in practices or behaviour

  • ● ● ● ○

    Cultural competency

    • System elements are aligned with and respect other cultures
    • Represents action on the part of an individual or organization

  • ● ● ● ●

    Cultural humility

      “…involves an ongoing process of self-exploration and self-critique combined with a willingness to learn from others. It means entering a relationship with another person with the intention of honoring their beliefs, customs, and values. It means acknowledging differences and accepting that person for who they are.” (University of Oregon, n.d.)

Key elements of cultural humility are:

Cultural humility is not...

(Fonda, Baptiste, Reinholdt & Ousman, 2015).

Another component of the spectrum is cultural safety. Safety is determined by the recipient of the service and not the provider. This is a shift away from what happens in the other points of the spectrum, which are mostly about the provider or the organization. Cultural safety is the voice of the client (First Nations Health Managers Association and Canadian Foundation for Healthcare Improvement, n.d)

Video: Benefits of cultural humility

With Vince Pietropaolo (General Manager, COSTI Family and Mental Health Services)

One of the benefits of practicing cultural humility is that you develop a deeper understanding of your clients situational issues as well as understanding the historical issues and realities of that particular culture and individual so you can have conversations where you are clarifying, where you're having a deeper understanding, maybe be more compassionate, empathetic and really understand and develop a perception that is more accurate and more in line with the values and attitudes that your client brings when they're discussing a particular issue or an event in their lives. When clients feel understood, they are more motivated to work towards their goals, when they feel trusted, when they feel that their culture and their views are affirmed there's more likely to be a higher motivation to work their goals and you have better outcomes. The effects when a service provider does not practice cultural humility can affect the trusting and nurturing relationship in a client-service provider setting. Clients can feel that they're not believed, they can feel that they're judged and often they can turn away from mental health professionals or other service providers. It is not just one individual in an organization that will practice but the importance of all colleagues and all staff in a particular centre or organization. Addressing power imbalances may begin with the client in a client-service provider relationship, however it's important that an organization practices cultural humility therefore it creates opportunities, it creates a welcoming and safe environment for clients and individuals to feel safe, feel trusted, and feel like they're being heard which makes a significant difference in the outcome of issues that immigrant and refugees face.