Armchair Discussions
Canadian School of Public Service
Ottawa
28 February 2008
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
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 Population
Newcomer 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.
December 2007. Available URL: http://www.statcan.ca/Daily/English/071204/d071204a.htm
The Daily: 4
Newcomer Youth
 Children 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 Health
 Without 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.
Theoretical Perspectives
Approaches to examining immigrant health:
1. Morbidity-mortality hypothesis
2. Healthy immigrant effect
3. Transitional effect
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.
---------------------------------------------------------------------------------------------------------------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 Effect
 2000/01 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
 Immigrant
 Refugee
 Precarious status
 Also helpful to distinguish between phases
 Pre-migration
 Migration
 Post-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 Promotion
Immigrant 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 Resilience
 Capacity 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 Youth
Barankin, T., & Khanlou, N. (2007). Toronto: CAMH (Centre for Addiction and Mental Health).
Systems involved
Individual
Family
Environment
Barankin & Khanlou (2007)
Environmental Factors
 Inclusion
 Having a sense of belonging


Gender
Culture
 Social conditions
 Society promoting resilience


Socio-economic situation
Media influences
Barankin & Khanlou (2007)
Environmental Factors (continued)
 Access
 Systems promoting resilience


Education
Health
 Involvement
 Youth’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 together
 Resilience is developed
within the context of
multiple systems.
Individual
Family
Environment
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 postmigratoires. 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]
Relationships
 Friends
 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)
25
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 Findings
 Important 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 acrosssystems.
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 Khanlou
CERIS – The Ontario Metropolis Centre
University of Toronto
nazilla.khanlou@utoronto.ca