Several factors are complicating access to adequate mental health care for Nova Scotia immigrants
Life can be tough, especially these days. Between the pandemic, skyrocketing inflation, climate concerns, and social upheaval (not to mention the day-to-day stressors we all face) it shouldn’t be a surprise that many of us can struggle with our mental health.
But all of that is true for Nova Scotian newcomers too, on top of the unique stressors immigrating to a whole new culture can bring. According to Carmen Celina Moncayo from the Immigrant Services Association of Nova Scotia (ISANS), having a solid mental health support base can make the difference between acclimating successfully and struggling to find your place in your new home.
Moncayo, a supervising team lead for Family, Children, and Specialized Supplement Services at ISANS, was a community psychologist in Colombia before moving to Canada at the turn of the millennium. In 2016, she helped create the Newcomer Community Wellness Program at ISANS, which aims to help newcomers build resilience in the face of a major life change.
“I was asked to do a deep assessment of the mental health issues facing newcomers. That helped us to shape the program we offer at ISANS,” Moncayo says. “In general, when newcomers arrive in Canada, they experience what we call ‘settlement stress.’ Some people call it cultural shock.
“It’s not just one thing that happens and then you settle down; it could last for a long time. It comes from being in a new country, where you need to renew, change, and adapt,” she says. “People face multiple stressors during the settlement process that can create anxiety and depression.”
Some of these stressors include language barriers, discrimination, a change in your position in your family, your status in the community, and even a sense of grief for your old life.
Refugees Face Even More Challenges
Worst-case, one’s road here may have been paved with traumatic events, such as war, famine, or violence.
“Also, we serve people who come as a government-assisted refugee, people who have had to leave their countries because of war,” Moncayo says, adding that some refugees suffer from more severe conditions like PTSD. “Overall, refugees could experience more mental health difficulties due to their traumatic experiences.”
Housing, Doctor Crises Add More Stressors
Social determinants can also factor in. Moncayo points to the current housing crisis in Nova Scotia, a dilemma concerning many of us, newcomer or no, as an example of something technically unrelated to mental health care that absolutely has an impact on mental health.
“Right now, in the context in Nova Scotia, one of the issues is the difficulty in finding affordable housing. It doesn’t matter how healthy you are, people are very worried about where thier family is going to live.
“The majority of newcomers… they have a hard time finding a family doctor,” Moncayo says, referring to Nova Scotia’s other current major crisis. “That adds stress. Newcomers face the same challenges locals face accessing mental health.”
Access to mental health care can be of vital importance to the newcomer community, since these settlement stressors can make acclimating and becoming part of the community more of a challenge than it would be for their neighbours.
But like their neighbours, gaining access to robust mental health care can be a challenge in Nova Scotia, with there being more demand than the public system can usually accommodate. And even if a newcomer does find a therapist, cultural barriers can remain.
“It requires more work when you are working with newcomers who don’t speak English,” Moncayo says. “Clinicians need to be trained to work with interpreters, and clinicians need to have cultural competency.”
Help Navigating the System
The Community Wellness Program at ISANS isn’t a mental health clinic, but more of a toolkit to help newcomers build their own resiliency, and to learn how to best maneuver the supports that are available to them.
“What we do at ISANS to support newcomers is to build their resilience, to help them strengthen their coping mechanisms,” she says, citing a client she recalls who faced a toxic work environment. “The client was being discriminated against at work. Racial discrimination, by the manager. Of course, you know how racial discrimination affects mental health, in terms of feeling disempowered, out of control, alienated.”
Moncayo says ISANS connected them with a counsellor who first acknowledged the complex, dehumanizing feelings they were having in response to the discrimination, a reality often downplayed in our society. Having validated their concerns, ISANS then came up with strategies for the client on how to get support from human resources, and on navigating what the law said about their rights.
“That person also found an ally in the organization,” Moncayo says. “That was one of the strategies.”
The Community Wellness Program offers lots of other strategies, from planning realistic goals, to connecting newcomers with organizations to volunteer with in their community, and indeed, referring clients to the community mental health system. But as much as they’re doing at ISANS, Moncayo says it’s just the tip of the iceberg.
Lots More Needs to be Done
“Still, there is a lot of work to do, in terms of government agencies,” she laments. “In terms of tailoring their services to the needs of immigrants… any kind of changes in how you provide services for immigrants will benefit the lives of the larger population.”
Until that hard work and investment in the community begins to happen, Moncayo has some advice for readers feeling the weight of the world on their shoulders after travelling half-way around it to arrive here in Nova Scotia.
“Reflect on your past experiences. Acknowledge all the resources you have. How, in the past, you have been able to manage and handle other crises? To connect with others, and to speak about it, to normalize. It’s very important to acknowledge that some of those symptoms are normal responses to situations of change. It’s a normal response to the disruption of their lives. That is where our program takes place.”
SIDEBAR – Common mental health ailments among newcomers
Not everyone who immigrates to Nova Scotia, or to Canada and most anywhere else, are sure to experience mental health concerns. At least not major ones.
“Some clients experience serious mental health illnesses, but related to the [general] mental health population, the percentage is low,” says Carmen Celina Moncayo, a supervising team lead for Family, Children, and Specialized Supplement Services at ISANS.
For most, the mental health issues that do arise tend to be the same ones many of the rest of us deal with: anxiety and depression.
Moncayo attributes much of this to a sense of loss of control that can come with relocating to a new city amidst a new culture. The way in which the world used to work back home may not be how things work here, and that can be disruptive to anyone.
“Very few people are prepared for how the changes are going to affect their mental health,” Moncayo says. “It takes them by surprise.”
Canada has also welcomed many refugees in recent years, with Nova Scotia welcoming more than 9,000 new permanent residents (a new record) in 2021. Many come here with anxiety and depression too, along with disruptions to, or outright dissolutions of, the family unit and other trauma.
According to a study published by the Child and Youth Refugee Research Coalition titled Mental Health Issues Affecting Refugee Youth in Canada who Experienced Family Loss and Separation in their Country of Origin: “[t]he most commonly reported mental illnesses among the youth were post-traumatic stress disorder (PTSD), depression, and anxiety.” The report goes on to say, “[t]he current support service and policies in Canada are serving refugee youth to meet their needs partially. There is an opportunity to build the capacity of the service providers with generated evidence, make the service navigation tools more user-friendly, and advocate amendment of the policies to address the real needs of the separated refugee youth.”
Another study posted by Statistics Canada, titled The mental health of immigrants and refugees: Canadian evidence from a nationally linked database, discusses the Healthy Immigrant Effect (HIE), where immigrants tends to arrive in Canada healthier than the general local population. However, “this initial health advantage seems to disappear over time, partly because of stress and other integration challenges. Whether this HIE and its deterioration also apply to mental health is an area of ongoing research.” Given Canada’s rising immigrant population, the study concludes, “[b]ecause of the growth in Canada’s immigrant population, it is important to monitor the health—including mental health—of immigrants.”