Tailor immigrant and refugee mental health services for culture, language, report urges

Canada must match its multicultural, open-door immigration policy with tailored mental health services or face inflated costs for crisis care down the road, warns a new report being released today.

The sweeping study by the Mental Health Commission of Canada, obtained by CBC News, finds that immigrants generally arrive with better mental health than the Canadian-born population something referred to as the "healthy immigrant effect."

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But their condition tends to deteriorate over time, and they don't get help due to stigma, fear of being removed from the country, or a lack of treatment that meets their cultural or language needs.

Refugees afflicted with post-traumatic stress disorder, anxiety or depression are even less likely to access services.

The report says Canada must "urgently" develop a mental health strategy aimed at boosting service uptake, on the grounds of both equity and cost-efficiency.

Reduce overall costs

"By working to reduce disparities in access to services, the appropriateness of services used, and mental health outcomes, Canada can reduce overall system costs," the report concludes.

Failure to access early treatment leads to more expensive emergency department visits or hospital admissions. There are also indirect economic effects, such as lost productivity and costs to the criminal justice system.

Entitled "The Case for Diversity," the report calls for greater investment in programs and treatments that are adapted for culture and language and tailored to trauma and migration stress.

Dr. Kwame McKenzie director of health equity at the Centre for Addiction and Mental Health, a psychiatry professor at the University of Toronto, and one of the report's authors said a newcomer's ability to make money, land a job, learn the language and find housing and social supports are key factors in mental health.

Mental health problems can often be prevented by easing the resettlement process and breaking down barriers to early treatment, he added.

Early intervention, reduced costs

"If you have evidence-based interventions and they have easy access to it, we'll be able to get people better and get them on their way," McKenzie said.

Yet despite evidence early intervention not only helps outcomes and cuts costs over time, a study of data in Ontario in the report shows a "stark disparity" in service use. Only 6.3 per cent of refugees access treatment, compared to 9.6 per cent of immigrants and 12.5 per cent of non-immigrant Canadians.

Pointing to the intake of Syrian refugees to Canada, McKenzie said positive resettlement steps that have been taken could help mitigate mental health problems.

"I think for the Syrian refugees, there's a lot of evidence accruing that the response, and the particular response in Canada, has been really good," he said. "So it may be that we'll see lower levels of mental health problems than we've had in other groups because of that."

Culturally adapted programs

"The Case for Diversity" project reviewed 408 studies involving 41,920 people, offering "significant evidence" that culturally adapted therapies are more effective than programs targeting culturally mixed groups.

"Diversity has been a hallmark of contemporary Canadian society and it should be foundational to the planning and delivery of mental health services at all levels," the report concludes.

"Meeting the needs of IRER [immigrant, refugee, ethno-cultural and racialized] populations is an urgent priority for the Canadian mental health system and its service providers."

Some other highlights in the report:

• Calls for improved collection and evaluation of data on ethnic background.
• Finds that culturally adapted programs increase client satisfaction and compliance and produce better health outcomes.
• Says addressing social determinants for immigrant, refugee and racialized populations is "paramount" to an effective strategy.

On Monday, federal Health Minister Jane Philpottsaid she wants to improve mental health services in Canada.

"The statistics around mental health and mental illness in this country are appalling," she said. "We are seeing rising suicide rates in young people. We are seeing dramatic productivity losses in this country because people are going with untreated mental illness.

"There's an excellent economic argument for improving investments in mental health."