This module described how clients access or use services, how serviceproviders can effectively facilitate mental health care for newcomer clients and how to effectively work with interpreters. A variety of factors influence how immigrant and refugee clients seek mental health care, including awareness of services, language, stigma and socioeconomic status. Service providers play a leading role in connecting clients with services, as well as overcoming barriers, conveying the importance of primary care and maintaining awareness of the role of culture in treatment. This module also discussed the important role of interpreters, including how they can benefit clients and how service providers can work effectively with interpreters.

Module 9 builds on how care providers can better connect clients with appropriate services through building partnerships and engaging in strategies to promote mental health.

References

8.1 — Navigating mental health services

• Statistics Canada. (2018). Mental health care needs, 2018. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00011-eng.htm

• Government of Canada. (2021, March 25). Just for You - Immigrants. Retrieved from Health Canada: https://www.canada.ca/en/health-canada/services/healthy-living/just-for-you/immigrants.html

• Ng, E., & Zhang, H. (2021, June 16). Access to mental health consultations by immigrants and refugees in Canada. Retrieved from Statistics Canada: https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2021006/article/00001-eng.pdf?st=lgpxTEVe

8.2 — Facilitating effective service use

• Al Masri, H. (2018). Cultural barriers in accessing mental health services and the role of cultural brokers. Webinar presented for the Immigrant and Refugee Mental Health Project, April 2018.

• Alarcón, R.D. (2020). Global Perspectives on the Teaching and Learning of Intercultural Psychotherapy. In M. Schouler, & M.C. Kastrup (Eds.), Intercultural Psychotherapy: For Immigrants, Refugees, Asylum Seekers and Ethnic Minority Patients (pp. 251-261). Switzerland: Springer Nature.

• American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, V.A.: American Psychiatric Association.

• Bauer A.M. & Alegria, M. (2010). Impact of Patient Language Proficiency and Interpreter Service use on the quality of psychiatric care: A systematic review. Psychiatric Services, 61 (6),765-773.

• Behnia, B. (2003). Refugees' convoy of social support. International Journal of Mental Health, 32 (4), 6-19.

• Bettmann, J.E., Penney, D., Freeman, P.C., & Lecy, N. (2015). Somali refugees' perceptions of mental illness. Social Work in Health Care, 54 (8), 738-757.

• Fernando, S., & Keating, F. (2009). Mental health in a multi-ethnic society: A multi-disciplinary handbook (2nd ed.). London, UK: Routledge.

• Flores, G. (2005). The impact of medical interpreter services on the quality of health care: A systematic review. Medical Care Research and Review, 62 (3), 255-299.

• Hansson, E., Tuck, A., Lurie, S., & McKenzie, K. for the Task Group of the Services Systems Advisory Committee, Mental Health Commission of Canada. (2010). Improving mental health services for immigrant, refugee, ethno-cultural and racialized groups: Issues and options for service improvement. https://mentalhealthcommission.ca/resource/improving-mental-health-services-for-immigrant-refugee-ethnocultural-and-racialized-groups-issues-and-options-for-service-improvement/

• Hassan, G., Kirmayer, L.J., Mekki-Berrada, A., Quosh, C., el Chammay, R., Deville-Stoetzel, et al. (2015). Culture, context and the mental health and psychosocial wellbeing of Syrians: A review for mental health and psychosocial support staff working with Syrians affected by armed conflict. Geneva, SW: UNHCR. Available: http://www.unhcr.org/55f6b90f9.pdf. Accessed May 4, 2018.

• Johnsdotter, S., Ingvarsdotter, K., Östman, M., & Carlbom, A. (2011). Koran reading and negotiation with jinn: strategies to deal with mental ill health among Swedish Somalis. Mental Health, Religion & Culture, 14 (8), 741-755.

• Karliner, L.S., Jacobs, E.A., Chen, A.H., & Mutha S. (2007). Do Professional Interpreters Improve Clinical care for patients with limited English proficiency? A systematic review of the Literature. Health Research and Educational Trust, 42 (2), 727-754.

• Kirmayer, L., Narasiah, L., Munoz, M., Rashid, M., Ryder, A.G., Guzder, J., et al. (2011). Common mental health problems in immigrants and refugees: General approach in primary care. Canadian Medical Association Journal, 183 (12), E959-E967. Available: https://dx.doi.org/10.1503/cmaj.090292

• Kirmayer, L., Guzder, J., Rousseau, C. (2014). Cultural Consultation: Encountering the other in mental health care. New York, NY: Springer New York, NY.

• Kovandzic, M., Chew-Graham, C., Reeve, J., Edwards, S., Peters, S., Edge, D., et al. (2011). Access to primary mental health care for hard-to-reach groups: From 'silent suffering' to 'making it work'. Social Science & Medicine, 72, 763-772.

• Laher, N., Sultana, A., Aery, A., & Kumar, N. (2018). Access to Language Interpretation Services and its impact on clinical and patient outcomes: A scoping review. Toronto, Ontario: Wellesley Institute. https://www.wellesleyinstitute.com/wp-content/uploads/2018/04/Language-Interpretation-Services-Scoping-Review.pdf

• McColl, H., McKenzie, K., & Bhui, K. (2008). Mental healthcare of asylum-seekers and refugees. Advances in Psychiatric Treatment, 14 (6), 452-459.

• McGill University. (n.d.). Cultural consultation service clinical handbook. Available at: https://www.mcgill.ca/culturalconsultation/handbook. Accessed May 4, 2018.

• Moodley, R., Sutherland, P., & Oulanova, O. (2008). Traditional healing, the body and mind in psychotherapy. Counselling Psychology Quarterly, 21 (2), 153-165.

• Pandey, M., Maina, R.G., Amoyaw, J., Li, Y., Kamrul, R., Michaels, C.R., & Maroof, R. (2021). Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. BMC Health Services Research, 21: 741. https://doi.org/10.1186/s12913-021-06750-4

• Paniagua, F. (2014). Assessing and Treating Culturally Diverse Clients: A Practical Guide (4th Edition). Thousand Oaks, California: Sage Publications.

• Pottie, K., Greenaway, C., Feightner, J., Welch, V., Swinkels, H., Rashid, M., et al. (2011). Evidence-based clinical guidelines for immigrants and refugees. Canadian Medical Association Journal, 183 (12), e824-e925.

• Racin, L., & Dein, S. (2020). Religion and Spirituality in Intercultural Therapy. In M. Schouler, & M.C. Kastrup (Eds.), Intercultural Psychotherapy: For Immigrants, Refugees, Asylum Seekers and Ethnic Minority Patients (pp. 161-175). Switzerland: Springer Nature.

• Stewart, M.J., Anderson, J., Beiser, M., Mwakarimba, E., Neufeld, A., Simich, L., et al. (2008). Multicultural meanings of social support among immigrants and refugees. International Migration, 46 (3), 123-159. DOI: 10.1111/j.1468-2435.2008.00464.x.

• Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Improving Cultural Competence. Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) 14-4849. Rockville, MD: Substance Abuse and Mental Health Services Administration.

• Vasilevska, B., Madan, A., & Simich, L. (2010). Refugee mental health: Promising practices and partnership building resources. Toronto, ON: Centre for Addiction and Mental Health. Available: https://www.porticonetwork.ca/documents/1388035/1388826/refugee_mental_health_prompractices.pdf/ 8b5f3b0d-19e0-4816-966b-3bf818eb279a. Accessed April 25, 2018.

• Wintrob, R., & de Figueiredo, J.M. (2020). Intercultural Psychotherapy: An Historical Perspective. In M. Schouler, & M.C. Kastrup (Eds.), Intercultural Psychotherapy: For Immigrants, Refugees, Asylum Seekers and Ethnic Minority Patients (pp. 1-24). Switzerland: Springer Nature.

• World Health Organization (WHO). (2010). How health systems can address health inequities linked to migration and ethnicity. Copenhagen, WHO Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0005/127526/e94497.pdf Accessed May, 2018.

• WHO. (2018). Health promotion for improved refugee and migrant health (Technical guidance on refugee and migrant health). Copenhagen: WHO Regional Office for Europe.

8.3 — Language and its effects on access to care

• Bauer A.M. & Alegria, M. (2010). Impact of Patient Language Proficiency and Interpreter Service use on the quality of psychiatric care: A systematic review. Psychiatric Services, 61 (6),765-773.

• Betancourt, J.R., Renfrew, M.R., Green, A.R., et al. (2012). Improving patient safety systems for patients with limited English proficiency: a guide for hospitals. (Prepared by the Disparities Solutions Center, Mongan Institute for Health Policy at Massachusetts General Hospital and Abt Associates, Cambridge, MA, under Contract No. HHSA290200600011I). Rockville, MD: Agency for Healthcare Research and Quality; AHRQ Publication No. 12-0041. https://www.ahrq.gov/health-literacy/professional-training/lepguide/index.html

• Brisset, C., Leanza, Y., Rosenberg, E., Vissandjée, B., Kirmayer, L. J., Muckle, G., et al. (2014). Language barriers in mental health care: A survey of primary care practitioners. Journal of Immigrant and Minority Health, 16 (6), 1238-46. doi: 10.1007/s10903-013-9971-9.

• Flores, G., Abreu, M., Barone, C.P., Bachur, R., & Lin, H. (2012). Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Annals of Emergency Medicine, 60 (5): 545-553.

• Healthcare Interpretation Network. (2007). National Standard Guide for Community Interpreting Services. Toronto, Canada: Healthcare Interpretation Network. https://industrie-langue.ca/en/certifications-and-standards/NSGCIS

• Institute of Medicine. (2009). Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement. Washington, DC: The National Academies Press. https://doi.org/10.17226/12696

• Nápoles, A.M., Santoyo-Olsson, J., Karliner, L.S., Gregorich, S.E., & Pérez-Stable, E.J. (2015). Inaccurate language interpretation and its clinical significance in the medical encounters of Spanish-speaking Latinos. Medical Care, 53 (11): 940-947.

• Schenker, Y., Lo, B., Ettinger, K. M., & Fernandez, A. (2008). Navigating Language Barriers Under Difficult Circumstances. Annals of Internal Medicine, 149 (4), 264-269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405855/