Mental health experts are calling for more culturally appropriate services for racialized immigrants in Canada in light of the recent death of a Sudanese-born father of five who was fatally shot by Toronto police officers earlier this month.
The Canadian Mental Health Association (CMHA) estimates that that one in five Canadians will develop a mental illness at some time in their lives. The association defines mental illness as a health challenge that undermines a person’s capacity to operate effectively in the world or to behave in socially-acceptable ways with others.
Across Boundaries, an ethno-racial community mental health centre based in Toronto’s west end, and the CMHA have both highlighted the heart-rending story of Andrew Loku, who was killed in an apartment complex near Eglinton Ave. W. and Caledonia Ave., Toronto, on July 5. Media reports suggest Loku’s apartment was in a CMHA-leased building that housed those suffering from mental illness.
While Canadian society as a whole grapples with the stigma and ignorance surrounding mental health, Across Boundaries’ executive director Aseefa Sarang says, the challenge facing immigrants is immeasurably more complicated.
“Hiding” the illness
“The gaps are based on many levels,” says Sarang. “They range from immigrants understanding the mental health system, to stigma around mental health and addictions, to discrimination (all sorts of oppressions) experienced, as well as structural barriers to accessing care. Many immigrants have a tendency to “hide” the illness and not share their condition with others or seek help.”
Immigrants are often faced with more challenges when and if they do seek assistance, Sarang adds. “It is another battle to find the right type of help, with the right type of people and help that is relevant to their needs (i.e. a combination of medical and non-medical supports – Ayurveda, acupuncture, yoga, etc.).”
While Canadian society as a whole grapples with the stigma and ignorance surrounding mental health, Across Boundaries’ executive director Aseefa Sarang says, the challenge facing immigrants is immeasurably more complicated.
The gaps in accessing services become clear in related research. For example, a 2012 report prepared by St. Michael’s Hospital, “The Mental Health and Well-being of Immigrants in Toronto”, indicates that while recent immigrants and non-recent immigrants experience about the same level of mental health issues like depression and anxiety as those born in Canada, when it comes to treatment for depression, immigrants are less likely to access services (less than seven per cent) compared to non-immigrants (10 per cent).
A personal story
Mental health survivor Aaqilah Al Massri is all too familiar with the challenges of accessing mental health services.
“The gaps in the system are in the very framework from which we understand and accept what contributes to mental un-wellness, which within a western landscape is derived primarily from a bio-medical model with the interventions being largely pharmacological,” says Al Massri.
Al Massri’s point is also highlighted in the St. Michael’s Hospital report, which shows fewer immigrants (13 per cent) use prescription medications to combat mental illness than non-immigrants (21 per cent). Furthermore, only eight per cent of immigrants saw a psychiatrist or psychologist in 2011, in comparison to 12 per cent of their non-immigrant counterparts.
Multi-layered challenges
Ryerson University School of Social Work professor I. Abdillahi says not all immigrants experience challenges with mental health services to the same degree. This has been illustrated in research examining the mental health experience of specific groups of immigrants and racialized people – for example studies focused on newcomer youth, African-Canadians in Montreal, Chinese-Canadian elders and Afghans in Toronto.
Abdillahi calls on mental health organizations to acknowledge that inequality is in-built into Canadian society, “which certainly impacts not just the day-to-day well-being of racialized people, but they (facets of inequality) have a particular perniciousness and precariousness depending on who are in these groups.”
Al Massri echoes this sentiment – underlining the need to recognize the impact of multiple oppressions.
“Traumatized or wounded people go on to wound and traumatize, and when the individual’s trauma is exacerbated by the very core of their social and cultural identity being under siege in their community (female and deeply questioning of the status quo), and within the larger framework of a largely racist system – in my case being of Palestinian, African and Muslim heritage – barriers become plentiful and that in itself contributes to stress and anxiety.”
Interpreting body language
This type of complex, multi-layered challenge becomes prevalent when examining the African-Canadian community’s relationship with the mental health system, Sarang finds.
“Based on our experience the black community is over represented in many spheres of the system. Our own experience at Across Boundaries shows that of our clientele, there are about 50 percent black people when the black population in Toronto is way less than that. This alludes to many layers of issues from racism to anti-black racism and impacts black people from all over the world.”
Loku’s shooting drives home the point. “Today I don’t question whether this is anti-black racism. In fact, this sort of action is a clear and deliberate act of anti-black racism, and the [Special Investigations Unit], the Toronto police and the community need to acknowledge this and seek accountability.”
According to Sarang, Black bodies are understood and interpreted as dangerous, unsafe and disruptive” and, as such, the response to this group can only be combative and fatal. Therefore, anti-Black racism is a cause of mental illness among African-Canadians.
Abillahi indicts anti-Black racism as a force that prevents access to appropriate and relevant services. African-Canadians are seen as “dangerous, unsafe, unwell, ill, untreatable, treatment resistant and non-compliant”. As result of these prejudices, the diagnosis and treatment take on a punitive character.
Offering solutions
Since there are problems with accessing mental health services that address the diverse needs of racialized Canadians – immigrants and refugees in particular – there is a need for the system to respond differently.
“First there has to be a clear acceptance that there is inequity at play in the system, and that there is institutional racism, which is compounded by individual racism,” says Sarang. “From there we can move to address the sources of inequities and finally consider strategies to overcome those inequities.
Al Massri adds that racialized communities require spaces to share more spoken narratives, and the sharing must be guided by, “compassion, empathy, respect, generosity of spirit and commitment to individual, familial and communal healing.”
