Nazilla Khanlou, RN, PhD 1 1 Health & Wellbeing Domain Leader, CERIS – The Ontario Metropolis Centre Associate Professor, LSB Faculty of Nursing & Department.

Nazilla Khanlou, RN, PhD1

1 Health & Wellbeing Domain Leader , CERIS – The Ontario Metropolis Centre Associate Professor, LSB Faculty of Nursing & Department of Psychiatry, University of

Toronto

Armchair Discussions Canadian School of Public Service

Ottawa28 February 2008

Overview 1. Context (Immigrant population, Newcomer youth)

2. Mental health (What is it?, Healthy immigrant effect)

3. Resilience (Why is it important for mental health?)

4. Research example

5. Discussion

Immigrant PopulationNewcomer Youth

Immigration – 2006 Census

Over 6 million foreign-born (close to 20% of population); highest proportion in 75 years

Between 2001-2006, over 1 million immigrants to Canada

Approximately 60% of newcomers from Asia (compared to 12% in 1971), 16% from Europe (62% in 1971), 11% from Central and South America, and 11% from Africa

Over 70% of foreign-born mother-tongue other than English or French (over 18% Chinese, over 6% Italian)

Close to 70% of recent immigrants in Toronto, Montreal and Vancouver

Most foreign-born (85%) eligible for Canadian citizenship, naturalized

Note: Numbers above have been rounded.

Statistics Canada. (2007). 2006 Census: Immigration, citizenship, language, mobility and migration. The Daily: 4 December 2007. Available URL: http://www.statcan.ca/Daily/English/071204/d071204a.htm

Newcomer YouthChildren and youth make up a significant portion

of immigrants into Canada

Over last decade (1997-2006) 0 to 14 years (over 20% each year)15 to 24 years (over 13% each year)

In 2006 0-14 years/2006 = 51,320 (20.4% of 251,649)15-24 years/2006= 40,674 (16.2% of 251, 649)

Citizenship and Immigration Canada. (2007). Facts and Figures 2006. Immigration Overview: Permanent and Temporary Residents 2006. Available URL: http://www.cic.gc.ca/English/resources/statistics/facts2006/permanent/05.asp

What is it?Healthy immigrant effect

Mental HealthWithout mental health there is no health

More than the absence of mental disorders“a state of well-being in which the individual realizes

his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”

Determined by socio-economic and environmental factors

Linked to behaviour

World Health Organization. (2007). Mental health: Strengthening mental health promotion. Fact Sheet # 220. Available URL: http://www.who.int/mediacentre/factsheets/fs220/en/

Mental Health Promotion“... the process of enhancing the capacity of

individuals and communities to take control over their lives and improve their mental health. Mental Health Promotion uses strategies that foster supportive environments and individual resilience, while showing respect for culture, equity, social justice, interconnections and personal dignity.”

Centre for Health Promotion. (1997). Proceedings from the International Workshop on Mental Health Promotion. University of Toronto. In C. Willinsky, & B. Pape. (1997). Mental health promotion. Social Action Series. Toronto: Canadian Mental Health Association National Office.

Approaches to examining immigrant health:

1. Morbidity-mortality hypothesis

2. Healthy immigrant effect

3. Transitional effect

Theoretical Perspectives

Alati, R., Najman, J.M., Shuttlewood, G.J., Williams, G.M., & Bor, W. (2003). Changes in mental health status amongst children of migrants to Australia: a longitudinal study. Sociology of Health and Illness, 25(7), 866-888.

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For a critique of sick immigrant and healthy immigrant paradigms see:

Beiser, M. (2005). The health of immigrants and refugees in Canada. Canadian Journal of Public Health, 96(Supplement 2), S30-S44.

Healthy Immigrant Effect2000/01 Canadian Community Health Survey

Immigrants lower rates of depression and alcohol dependence than Canadian-born

Healthy immigrant effect strongest among recent immigrants and immigrants from Africa and Asia (most recent immigrants from Asia and Africa)

Long term immigrants similar rates of depression as Canadian-born (most long term immigrants from Europe)

Findings consistent with those on physical health (immigrants in better physical health than Canadian-born)

Ali. J. (2002). Mental Health of Canada’s Immigrants. Supplement to Health Reports, volume 13, Statistics Canada, Catalogue 82-003, 1-11.

Healthy Immigrant Effect “Although it is clear that there are vulnerable

sub-groups among immigrants, it appears that most immigrants, particularly recent immigrants, exhibit fewer mental health problems than the Canadian-born population. Whether this pattern reflects greater resiliency or a difference in how immigrants approach stress and adversity in their lives is a question that could be addressed in future research.” (Ali, 2002, p. 6)

Ali. J. (2002). Mental Health of Canada’s Immigrants. Supplement to Health Reports, volume 13, Statistics Canada, Catalogue 82-003, 1-11.

Newcomer Youth Important to distinguish between status

ImmigrantRefugeePrecarious status

Also helpful to distinguish between phasesPre-migrationMigrationPost-migration

Khanlou, N. (2007). Young and new to Canada: Promoting the mental wellbeing of immigrant and refugee female youth. International Journal of Mental Health & Addiction. (Online: http://www.springerlink.com/content/7887281654x11468/)

Khanlou, N., & Guruge G. (2008). Chapter 10: Refugee youth, gender and identity: On the margins of mental health promotion. In: Hajdukowski-Ahmed M, Khanlou N, & Moussa H (Editors) Not born a refugee woman: Contesting identities, rethinking practices. Oxford/New York: Berghahn Books (Forced Migration Series).

Mental Health & Mental Health PromotionImmigrant receiving and multicultural societies

Mental health: a sense of mental well-being arising from interaction between individual and environment. Intersections of micro (e.g. health status, social networks) and macro (e.g. neighbourhoods, political instability, globalization) level influences.

Intersections of gender, life stage, cultural, migrant and racialized status on mental health promotion in multicultural settings must be considered.

Khanlou, N. (2003). Mental health promotion education in multicultural settings. Nurse Education Today, 23(2), 96-103.

Khanlou, N., Beiser, M., Cole, E., Freire, M., Hyman, I., Kilbride, K.M. (2002). Mental health promotion among newcomer female youth: Post-migration experiences and self-esteem. Ottawa: Status of Women Canada.

Why is it important for mental health?

Defining ResilienceCapacity to “cope with, and bounce back after, the

ongoing demands and challenges of life, and to learn from them in a positive way” (Joubert & Raeburn, 1998)

Positive adaptation to adversity; not the absence of vulnerability (Waller, 2001)

Is “a class of phenomena characterized by good outcomes in spite of serious threats to adaptation or development” (Masten, 2001)

Joubart, N., & Raeburn, J. (1998). Mental health promotion: People, power and passion. International Journal of Mental Health Promotion, Inaugural issue, September, 15-22.

Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56(3), 227-238.

Waller, M.A. (2001). Resilience in ecosystemic context: Evolution of the concept. American Journal of Orthopsychiatry, 71(3), 290-297.

Growing Up Resilient: Ways to Build Resilience in Children and YouthBarankin, T., & Khanlou, N. (2007). Toronto: CAMH (Centre for Addiction and Mental Health).

Systems involvedIndividual Individual FamilyFamilyEnvironmentEnvironment

Barankin & Khanlou (2007)

Environmental FactorsInclusion

Having a sense of belonging Gender Culture

Social conditionsSociety promoting resilience

Socio-economic situation Media influences

Barankin & Khanlou (2007)

Environmental Factors (continued)

AccessSystems promoting resilience

Education Health

InvolvementYouth’s participation in the world around them

Barankin & Khanlou (2007)

Environmental – examples of protective factors Policies (local to national) promoting

equity, justice, inclusion Access to community resources (e.g.

public transportation) Supportive and safe school

environments Living in a safe and caring

neighbourhood Access to counsellors & mental

health & addiction services as needed Positive media messages Contact with caring adults (e.g.

teachers, coaches, etc) Links to strong cultural community

(sense of history, feelings of belonging)

Involvement in healthy physical, recreational, and volunteer activities

Barankin & Khanlou (2007)

Putting it all togetherResilience is

developed within the context of multiple systems.

Newcomer Youth

Newcomer Youth Study Khanlou, N., Beiser, M., Cole, E., Freire, M., Hyman, I., & Kilbride, K.M. (2002). Mental health promotion among newcomer female youth: Post-migration experiences and self-esteem/ Promotion de la santé mentale des jeunes immigrantes: Expériences et estime de soi post-migratoires. Ottawa: Status of Women Canada .

Self-concept Khanlou, N., & Crawford, C. (2006). Post-migratory experiences of newcomer female youth: Self-esteem and identity development. Journal of Immigrant and Minority Health, 8(1),45-56. [Figure 1: Self-concept theme and sub-themes, p. 50]

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RelationshipsFriends

Ya, because we are still ESL students, sometimes we can’t speak English very well, and then, those maybe Canadian born or those English speakers don’t really talk to us, sometimes, but they do but not much. (P2, FG1)

.

Systems issues

“She feels different because in certain occasion children make her feel different. You know, her hair is different of course, her colour is different than other children, and she had an accent, but she doesn’t have the accent now, ya, but she had an accent. And you know, and always being asked where do you come from?” (PA3, PI2)

.

Systems issues

“Because, I mean if you, you think if kids come with parents who are doctors and nurses and they come here. Parents have to end up in factory, they’re frustrated, that frustration is passed on to the children as well.” (S2, Meeting with SEPT workers)

Key FindingsImportant role of gender in settlement experiences of

newcomer immigrant youth.Language barriers significantly influenced different

aspects of youths’ lives (e.g. school outcomes, peer relationships).

Discriminatory attitudes and family settlement barriers can impact youths’ mental health.

Despite challenges, youth had positive outlook on their future and high motivation for educational and career success.

15 policy recommendations made addressing: education system, health and social services systems, resettlement services, and across-systems.

Policy Recommendations: Health & Social Services Systems

Educate health & social services professionals working with newcomer female youth in cultural sensitivity.

Across the health system, provide appropriate MHP initiatives for newcomer female youth.

Focus on strengths of newcomer female youth as well as their challenges. Foster youth participation in decision-making fora related to health & social services planning.

Policy recommendations: Across Systems

Develop and co-ordinate partnerships (including health, education, social and resettlement services) across systems.

Adopt culturally sensitive, anti-discriminatory policies and strategies in institutions that work with newcomer female youth and their families.

Thank you!

Nazilla KhanlouCERIS – The Ontario Metropolis

CentreUniversity of Toronto

[email protected]