Refugee Mental Health Overview of post-migration protective factors

Mental health = Successful integration

• Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

World Health Organization, 2014

Social integration = Social inclusion

• Having equal access to opportunities and resources • The ability to participate meaningfully in society’s

economic, social, and political life • Feelings of belonging

• In terms of changes in skills and knowledge of refugees • In terms of attitudes, beliefs and behaviours of settlement

community and institutions

Ager & Strang, 2008; Smith, 2008; Strang & Ager, 2010

Language Culture Functional

Interactional

Social Identity

Socio-economic Context

Personal History

Social Connections

Institutional Adaptation

Social

Sense of Belonging

Safety & Security

Subjective

Community Welcome

Holistic Integration Model

Promoting mental health

• Able to realize own abilities

• Cope with the normal stresses of life

• Work productively • Make a contribution to

his or her community

• Access to education

and meaningful employment

• Having strong social relationships

EDUCATION AND EMPLOYMENT

School and work are the primary social milieu for youth and adults, after family

Successful integration is de facto successful integration

Refugee youth value education ; Adam & Inal, 2013; Edge, et al., 2014 Pastoor, 2015; Shakya et al., 2011

• When you study and become somebody in the future, you can be helpful to yourself and to your community. For example, there are lots of Afghan people here, and you can help them ... Not only Afghan community but all the communities. You can help through your knowledge or your field. I think the most important thing is education and schooling.

• Afghan Male focus group, Aged 16-19

Integration into school community

• More participation and sense of belonging associated with less depression, fewer traumatic symptoms, more self-efficacy

• You need to go through education and of course

through school you get connected to the community, you get to know the different cultures because at school you meet many people and make friends, and you feel more comfortable in the community where you’re living.

• Mixed Ontario refugee youth focus group

Hynie, 2014; Kia-Keating & Ellis, 2007; Korntheuer et al., 2016; Montgomery, 2010; Sullivan & Simonson, 2015

Employment associated with other integration outcomes

• ….Y.ou need to go down there, ok? And meet people and understand how they use the English. So the street English is totally different than the college English. So what I recommend, my personal approach would be you get a job, ok?

• Adult Mixed Focus Group

• Because you know, I told about from job, when you have job

and to give to Canada you feel this is your home. • Francophone GAR Focus Group

Hynie et al., 2016; Shakya et al., 2014

The importance of quality employment

• It’s is very low-income, we thought ‘we are brought here to be smashed’.

• Iraqi Mixed Adult Focus Group

• Worse mental health outcomes for refugees who are:

• Unemployed • Face financial difficulties • Employed in jobs that don’t meet their skills and

qualifications • Employment in jobs for which overqualified

Bambra et al., 2009 Besier & Hou, 2001; Campbell, 2012

SOCIAL CONNECTIONS

Beck, 2008; Cohen, 2004; Lakey & Orehek, 2011; Uchino, 2006; Xu & McDonald, 2010

Perceiving available and effective social support improves physical and mental health

Support from co-ethnic groups, agencies and family

• An Afghan settlement worker . . . they helped me with my

problems. I would go to them and tell them [about] my problem. They helped me because they are from my country.

• Afghan GAR interview

• …like if any family got trouble, any family pass away and

we just gather and like try to encourage their family. Leave a message or try to face them…try to encourage, if they need help for the transportation or anything they want

• Karen Male PSR Interview

Hynie et al., 2011; Hynie et al., 2012; McGrath et al., 2015

Concerns about relying on co-ethnic group

• Concerns about privacy • Basically, I pray, you know. . . . nobody is your friend if you get on your

knees, because, basically, when you have your problems and you go to someone and say, “I need this and I need that,” too many people hear about it on the street. . . .

• Refugee claimant interview

• Concerns about insularity and lack of integration • I personally would like to see that they interact with other community in

the church so that they would be able to practice language or socialize but when they were offered a Karen service program many of them withdrew from the English program

• Karen Male Interview

• Lack of capacity

Hynie et al., 2011; McGrath et al., 2015; Stewart 2014

Agency and sponsor support not always seen as helpful

• Agencies can be seen as ineffective • I feel myself like a loud animal in a cage. And this

cage is put in a well, and people from different services are watching and if I get out of this cage, I am still in this hole.

• Iraqi GAR Focus Group

• Support from PSR sponsors can feel intrusive or inappropriate

Besier, 2010; Hynie et al., 2016; Hynie et al., 2011

The challenge of culturally appropriate support

• Social support is understood differently in different cultures • Tends to be most effective when received from co-ethnic

group

Beiser, 2010; Simich et al., 2003

Promoting mental health

• Focusing on mental health promotion important because it changes the question • From: How can we prevent negative outcomes • To: How can we support refugees to achieve their full

potential

• The best thing about my settlement experience is feeling like a human being Karen Male PSR Interview

THANK YOU Michaela Hynie York Institute for Health Research Centre for Refugee Studies mhynie@yorku.ca

OUR RESEARCH PARTNERS Abrigo Centre; Access Alliance Multicultural Health Services; Black Creek Community Health Centre; Catholic Centre for Immigrants; COSTI Immigrant Services; Karen Canadan Community; London Cross Cultural Learner Centre; Multicultural Council of Windsor and Essex County; Reception House Waterloo Region; Thorncliffe Neigbhourhood Family Services; Wesley Urban Ministries; YMCA of Greater Toronto….