Question and Answer

The Immigrant and Refugee Mental Health Project facilitates a virtual Community of Practice (CoP) comprised of health, settlement and social services providers across Canada who support the mental health of immigrants and refugees. The CoP online discussion board allows providers to pose questions to the Project’s panel of subject matter experts (SMEs). We will be bringing you some of the questions posed by providers and answers provided by the SMEs.   

Question

Please advise on how to identify mental health issues existing in immigrants, especially refugees, because there is a very thin line between post immigration trauma and mental health stress/issues. What if we as settlement workers misidentify and misguide immigrants to resources where they shouldn't end up?

Thank you for this key question. On the whole I think its distress that needs to be identified and targeted in refugees, not mental illness.  If we can work to alleviate their distress through settlement services they will feel better whether or not they have a mental health issue.  The vast majority of refugees I see don’t have a mental illness/disorder but almost all are highly stressed by all the various refugee processes, settlement, the loss of their home and all that is familiar to them.  Your services as a settlement worker are key to the safety, security and wellness of refugees – if someone really does have a mental health disorder they will be better off for your services and over time you will have a better idea about where you might want to refer or what resources they might need.

Vanessa Wright, nurse practitioner, Crossroads Refugee Health Clinic, writes:

Thank you for your thoughtful question. Firstly, I think how valuable it is for you to be navigating such questions and complexities for your clients in the settlement sector. Situational stress is paramount in refugees particularly - due to the precarious situation many are leaving. I'll use a scenario to demonstrate, a social worker in a local refugee clinic collected her stats, and found that majority of clients would only see her 1-3 times for clearly directed concerns: housing, work/volunteer opportunities, immigration support/refugee law. Approximately 15% would see her for ongoing counselling, and from that 15%, only 5% were connected with the psychiatrist to address any outstanding mental health concerns/diagnosis/treatment. I raise this example, because it details the circumstantial stress and distress many newcomers are going through, and not an outlined mental health illness. I think the fact that you're there - and can connect them to a primary care provider is of utmost importance. It is the primary care providers job (medical doctor or nurse practitioner) to identify what is situational stress verse a mental health issue. In addition, simply connecting people to community resources is a wonderful act of allegiance - and one that I would encourage you to keep doing. At least 4-5 times/week I connect with settlement workers to discuss clients presentations - I welcome their input and collaboration. This field is not one of solitary work.