Identify the social factors that impact on individuals’ health
Review the role of service providers in improving the holistic health status of their clients
Explain the causes of mental health challenges of refugees/immigrants using social determinants of health framework
Motivate clients to seek support (professional/caregiver) through active engagement skills
2
The World Health Organization (WHO) constitution (1948) states:“Health is a state of complete physical, mental and social well-being and not merely the absence of Disease or Infirmity.”“resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.“(WHO,1986)
3
WHO defines Mental Health:
“a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
4
Factors that affect the mental health of immigrants and refugees which are beyond individual’s control: (Social determinants of health)
Income and social status
Education
Employment / Working conditions
Social environments
Physical environment
Healthy child development
Social support network
Source: The Public Health Agency of Canada
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• Adapting to a new culture
• Learning new language
• Coping with losses, i.e. family and social supports,
• Experiences of trauma before and after settlement
• Coping with discrimination
• Establishing the support network
• Unemployment and underemployment
• Changes in the socioeconomic status
• Seeking for culturally appropriate mental health care practices
Mental illness strikes 1 out of 5 Canadians
All Canadians are affected by mental health issues or mental illness
FALSE
11
Mental health factors, such as stress, anxiety, and
depression, don't affect your overall health as much
as physical factors.
True or False
Statement #2
12
Your state of mind is connected to and shapes all other bodily states,
and needs equal attention. Excess stress increases the release of the
stress hormone cortisol, which can further increase blood sugar and
accelerate progression to diabetes. This illustrates stress can directly
affect your physical health.
Source:Mental Health Myths in South Asians
http://www.pamf.org/southasian/risk/concerns/mentalhealthmyths.html
FALSE
13
14
Everyone has attitudes and judgments that affect how we think about and behave toward othersStigma refers to negative, unfavourable attitudes and the behaviour they produce. It is a form of prejudice that spreads fear and misinformation, labels individuals and perpetuates stereotypes.
Source: www.mentalhealthcommission.ca/English/Pages/OpeningMinds.aspx
Stigma:
prejudice and discrimination towards people with mental illness
misconceptions
discomfort with differences
fearing and avoiding what we don’t understand
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Many people living with a mental illness say the stigma they face is often worse than the illness itself.
Intertwined with and just as important as physical health
finding a balance in all aspects of your life
Finding a balance is a unique learning process
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•Biological•Environmental•Genetic
-Loss-Migration
-War-Trauma
•Access to adequate income, housing, employment, etc.•Community support•Coping ability•Personal strengths•Social inclusion•Social support
•Decreased health status•Inadequate housing•Inadequate income•Social exclusion•Stress•Unemployment
Physical &
Spiritual Health
Mental
Health
Source: Wong, J. P. (June 2006). Intersecting sexuality, gender, race & citizenship:
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Predisposing
Factors
Protective
Factors
Precipitating
Factors
Perpetuating
Factors
“In any given year, one in five people in Canada experiences a mental health problem or illness, with a cost to the economy of well in excess of $50 billion”
Source: Mental Health Commission of Canada. (2012). Changing directions, changing lives: The mental health strategy for Canada. Calgary, AB: Author.
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(not a check list or an exhaustive list)
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Physical symptom
s
Restlessness
Insomnia
Weight gain
or loss
Loss of appetite
Panic attacks
Poor concentra
tion
AngerCrying easily
Feelings of
sadnessLoss of
interest or motivation in
daily activitiesChanges in
relationships with family
members or peers
Does not automatically mean we have mental illness…
An anxiety disorder
Produced by an extraordinarily stressful event
Re-experiencing of this event through flashbacks
and nightmares
2-5% of population
30% of veteran involved in war
Male to female ratio: 1:2
Age of onset: any age, including childhood
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What are the Symptoms?
Difficulty falling or staying asleep
Unwanted thoughts, memories, images or dreams about the event
Acting and feeling as if the traumatic event is happening again
Extreme vigilance – feeling watchful all the time and being easily startled
Extreme distress when something reminds the person of the event
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Learn about mental health in the context of holistic
health
Understand associated factors and taking early steps to
change
Practicing mental fitness
Assessment & early treatment
Exploring strategies in promoting mental health &
coping with stress
Organizational & systemic changes beyond the
individual level24
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Medical Psychosocial
Psychiatric Medication Electroconvulsive Therapy Psychotherapy
Group Day Program ACTT Vocational program Psychosocial Peer Support Case Management Alternative Treatment Other community support
As unique and individual that mental health issues and addictions are to each patient/client, so too are their assessment and
treatment needs. -CAMH
“In general, immigrants and refugees are less likely than their Canadian-born counterparts to seek out or be referred to mental health services, even when they experience comparable levels of distress.”
(Chen AW, Kazanjian A., 2011)
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Cultural inclusive goes beyond linguistic competence and sharing the same country of origin
Presumptions, stereotypes, and playing the “expert” role can pose barriers to being culturally competent
Significance of culture as defined & perceived by the individual
Culture impacts on perception of mental health & mental illness
Stigma & its impact on help seeking behavior
It provides a culturally safe environment
Resource & Service Accessibility 29
• It is culturally relevant
• Address the social determinants
• Equitable access to services and programs
• Responsive to the needs of the clients’ groups
• Reflecting the diversity of the community that being
served
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CONNECTION BEFORE SOLUTION
EMPATHY BEFORE EDUCATION
Source: “Supporting Immigrants and Refugees in Distress Using
Tools from the Compassionate Communication™ Process” by
Mr. Henry Wai, NVC trainer
• Unemployment
• Poverty
• Social isolation
• Shame/guilt
• Racism and discrimination
• Language skills.¹
• Lack of mobility
• Inability to take time away from work
• Concern that problems will not be understood by practitioners because of cultural or linguistic differences. ²
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1. Sidher, 20112. Whitley R, Kirmayer LJ, Groleau D., 2006
• Engaging clients
• Early identification skills, assessment
• High-quality customer service provider
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I've learned that people will forget what you said,
people will forget what you did, but people will never forget how you made them feel.
Maya Angelou, author, poet, and activist
• is attentive• concentrates on the client• does not interrupt• gives nonverbal feedback (e.g., nodding, smiling, saying
"mmm") • reflects and acknowledges feelings (e.g., "You sound very
happy today.")• summarizes the main points back to the speaker• asks for clarification when needed, using open-ended
questions• always asks questions in a non-judgmental way, using a
tone of voice that expresses interest and concern.
CAMH, 2012
Focus attention on the speaker. A good active listener:
36
1. Cultural identity2. Cultural explanations of illness3. Cultural practices regarding to psycho-social practices4. Cultural elements between patient and health care
provider. 5. Cultural assessment and care plan.
Dr. Kenneth Fung, 2013
A section of the DSM recognizes that everyone has a culture and the following factors should always be considered when working with clients:
38
How people explain the causes of illnesses.
Ask to find out someone’s personal explanatory model of illness:
• What do you call the illness?
• Why does it exist/what caused it?
• Who should treat it?
• What treatment is needed?
The point to remember is that people can have the same illness, but experience it differently from each other.
Dr. Kenneth Fung, 2013
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Relating & Responding to Client: -Listening-Verbal & non-verbal communication (e.g. body language, )-Recognition & support V.s. Judging & Reasoning
Alternatives: - What’s Workable V.s. What’s not Workable- Strengths V.s. Problems- Hope V.s. Giving Up
Keep a needs-based focus.
Maintain confidentiality and safety.
Help empower clients.
Respect clients' self-determination and personal freedom.
Keep expectations realistic.
42
CAMH
Working on Client’s positives & strengths v.s. fixating on problems that do not have immediate solutions
Setting contract & boundary with the client through a trusting & supportive relationship: Without trust, setting limits can turn into a power struggleWith trust, rapport & listening, we can support client to enhance coping & social skills as well as possibly working towards getting other types of support & treatment (e.g. psychiatric treatment, mental health support services)
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• Facilitate the initial interviews to occur
– e.g. reminder; transportation; interpretation
• Provide support
• Provide information
45
Dr. Kenneth Fung, 2013
• Collaboratively identify the need and the most appropriate consultant(s) or service(s) and offer choice
• Clarify and implement the correct referral procedures
• Preparation for the consultation / services intake
– Who and what to bring?
– What to expect?
– Any barriers to going?
46
• Follow-up with the client
• Follow-up on the consultant / services
• Facilitate next steps
• Circle of care/consent
47