D7 Journey To Promote Mental Health: A workshop for Immigrant & Refugee Service Workers_Raymond C.Y.Chung & Maria Lo & Linda Yoo

Journey to Promote Mental Health: A Workshop for Community Workers Serving Ethno-racial Communities Hong Fook Mental Health Association Raymond Chung, Linda Yoo & Maria Lo April 23, 2009

Goals To heighten Participants’ awareness of the interconnectedness between Mental Health and Settlement Services To enhance Participants’ knowledge base on Wellness, Mental Health and Mental Illness

Outline • Welcome & Introduction • Holistic Health & Migration • Cultural Competence • Stigma & Mental Health Break Time • Introduction on Mental Health & Mental illness • Introduction of Mental Health System • Introduction to Community Resources

What makes someone healthy?

Most people think that our health is dependent on…

Some even think of “lifestyle”…

Employment Income Education Healthy Child Development Social Inclusion Social Determinants of Health Housing Food Safe Physical Health/Social Transportation Environment Services .

Factors Affecting our Mental Health and that are Particularly Important to Immigrants Income and social status Social support networks Education and literacy, i.e. health literacy Employment / Working conditions Social environments Physical environments Healthy child development Source: The Public Health Agency of Canada

Spirit MUTUAL UNDERSTANDING UNDERSTANDING Re R Mind Body p hi n sp o ns t o n le s ti o por io a at Ac si & l n ic Re mu S up bi ce Ca lit pa t or ss cit ie m y s Co pp Su Eq e s Resources rc ui ty ou R es Social Justice

What needs to be addressed in promoting mental health beyond the individual factors?

Health Disparities Result From… Biological/ Genetic Individual Lifestyles Health Societal Disparities Inequity In our social and health care system e.g. public policies that lead to inequitable distribution of resources & power; systemic oppressions & barriers.

Identifying the Stressors Associated With the Migration Process Case Example: Can you name stressors immigrants and refugees may face?

Case Example - Ling is a 20 yrs old new immigrant who came from China 2 years ago with her mother - Ling is unemployed and attending ESL class - she appears to be passive, submissive, withdrawn and seems to lack self confidence - Her mother was diagnosed with Depression in China some time ago but has not reconnected with any mental health services in Toronto - Ling is not sleeping well, waking up early, and talking about the lack of meaning in life after coming to Toronto - Her father has been here for 15 years and works long hours as a chef to support the family - The family shares a house with 2 other families with young children

Question: If you are the settlement worker serving Ling, what are the stressors in her circumstances that you would attend to in supporting her?

Identifying the Stressors Associated With the Migration Process Chronic Stress has been linked to the 6 leading causes of death: Heart diseases Cancer Lung ailments Cirrhosis of the liver Suicide Accidents 75-90% of all visits to healthcare professionals are for stress-related disorders (Source: The Stress Solution by Lyle H. Miller, Ph.D., and Alma Dell Smith, PhD)

Moving Beyond Information Services What could we do? as a frontline settlement worker…….. as an organization for your communities……. to make system changes……… to reduce health and social inequities?

Mental Health & Mental Illnesses: A Cultural Competence Framework

Cultural Competence

Othe der Gen r, etc La n gu ge ag A . Fait e R e li h/ a lity gion Sexu Diversity hysical Mental/P Ethnicity Abilities Ci l ti Soci ia ity ze ac nt R de St nshi oeco at p Class I us Statu nom ic s The Diversity Flower has been adopted from the Power Flower (Source: Arnold, R., Burke, B., James, C. & Martin, D. (1991) Educating for a Change, Toronto, ON: Between The Lines)

While we may acknowledge diversity, we must also acknowledge that inequities and oppressions exist… Sexism Racism Classism Heterosexism/ Ableism Homophobia Ageism Inequities Other Oppressions Each individual, group or community usually belongs to a set of Overlapping oppressions overlapping impact negatively on the dimensions well-being of the individual, group or community .

Definition of Cultural Competence “ A set of congruent behaviours, attitudes and policies that come together in a system, agency or among professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations “ (Cross et al, 1989).

Am I culturally competent if I … tell my Chinese client that I am Chinese too and an immigrant also, so I know what she is going through & needs to do. refer my client who is Vietnamese by ethnic origin to a Vietnamese-speaking counselor with the belief that this arrangement is culturally appropriate for her. share my client’s situation with his mother who did not tell her son that she was calling me with the assumption that family plays an important part in an individual’s life in Asian culture so parents should know what’s happening to their children.

Key Points Interpretation of Critical Self culture by the Awareness & individual Reflective Practice Stereotyping & Holistic Health Culture beyond labeling as language “Absolute No” Social Justice compatibility Equity Diversity Cultural Competence at Cultural Competence at Service Level Organizational Level Cultural Competence at System Level

Warm up activities!!!!

How do we see mental health & mental illness? Statement #1: People with mental illness are violent and dangerous Statement #2: People with mental illness are poor and/or less intelligent Statement #3: Mental Illness is caused by personal weakness Statement #4: If I do not have mental illness, it means I am having good mental health TRUE or FALSE

Stigma & Mental Illness Stigma relates to: Misconception of mental illness Lack of knowledge Discomfort with differences Fear Stigma & discrimination impacts on help seeking behavior & delay in treatment

15 minutes Break

What is Mental Health? Mental health is about striking a balance in the physical, mental, spiritual, social and economic aspects of our lives. Reaching a balance is a unique experience for each individual. Mental Health as a Continuum

Mental Health as a Continuum Wellness Illness

The 4 Ps of Mental Health • Precipitating factors: triggered by stressful events. • Predisposing factors: things that make a person more vulnerable to being distressed. • Perpetuating factors: things that prolong the problem. The person’s road to recovery may be affected • Protective factors: things that help recovery.

Some Early signs and symptoms of mental health issues (not a check list or an exhaustive list) • Physical fatigue and low energy • Restlessness • Insomnia • Panic attacks • Loss of appetite • Weight gain or loss • Physical symptoms, such as headaches and stomach aches

Other Common Symptoms • Increased irritability & anxiety • Racing thoughts • Poor concentration • Anger • Feelings of sadness • Crying easily • Changes in relationships with family members or peers, • Loss of interest or motivation in studies or work • Absenteeism from school or work

WHAT IS MENTAL ILLNESS? Mental illness is a medical condition that affects an individual’s thinking, mood and behaviour. Mental illness is an illness similar to physical illness, but it is “invisible" Mental illness is treatable and recovery is possible.

Different Types of Mental Illnesses Psychotic Disorders Examples: Schizophrenia, Delusional Disorder Mood Disorders Examples: Depression, Bipolar Affective Disorder Anxiety Disorders Example: Post Traumatic Stress Disorder Others

How common are Mental Illness & Addiction Issues in Canada? • 1 in 10 (aged 15 and over) – 2.7 million have symptoms consistent with a mood or anxiety disorder / alcohol or illicit drug dependence • 1 in 20 met the criteria for a mood disorder, either major depression or bipolar 1 disorder • 1 in 20 met the criteria for an anxiety disorder • 1 in 50 met the criteria for moderate risk or problem gambling • 1 in 30 met the criteria for substance dependence associated with either alcohol or illicit drug use (The Human Face of Mental Health and Mental Illness in Canada 2006)

Other Statistics & Facts (Source: Mood Disorder Society of Canada) Chances of having a mental illness in your lifetime in Canada: One in five Percentage of people with chronic depression who die from suicide: 15% Annual losses to the Canadian economy due to mental illness & substance abuse in the workplace: $33 billion Percentage of Canadian workers who experience a stress related illness per year: 20% Number of people with mental illness either turned down for a job for which they were qualified, or if employed, dismissed or forced to resign once it was known that they had mental illness 1/3 to 1/2

So What do we do with this knowledge?

MENTAL ILLNESS IS TREATABLE RECOVERY IS POSSIBLE!

Case Scenario • JJ is a 18-year old high school student • Immigrated to Canada 3 years ago, living with parents in their 50’s. • Used to like studying and get along with parents until 7 months ago • Became withdrawn, lied in bed all day, not speaking to parents, skipping classes • Ignoring personal hygiene, talking to self in his room, said news reporter on TV is referring to him when watching news • Parents upset about his changes and thought he could overcome his problem by pushing him to think and act differently

Any symptoms that we detect in JJ that are of concerns?

Treatment Approaches Psychiatric Medication ECT ACTT Psychotherapy Alternative Treatment Psychosocial Support Group Day Program Vocational program Peer Support Case Management Other Community Support

What can we do in dealing with mental health challenges? Early Identification Understand associated factors and taking early steps to change Assessment & Early Treatment Explore Strategies in promoting mental health & coping with stress Organizational & Systemic Changes beyond the individual level

Case Scenario: How do we provide support? • TK is a 35-year old female • Immigrated to Toronto 2 years ago from Mainland China • No English; university education • Living with 40-year old husband and 12-year old son • Couple were computer professionals in China • No job here and living on saving • Living on saving & tight finances • Poor marital relationship • Brother in Toronto & is supportive • Problems with Son’s behavior: seen as “rebellious” • TK is experiencing crying spells, loss of weight, poor sleep, social withdrawal • TK is questioning the meaning of life and expressed thoughts of not wanting to live

Case Scenario: How do we provide support? What is our assessment of his needs & areas to work on? How do we intervene?

How do we provide support? Questions to ask: Assessment Early Identification: What are the signs of mental health issues? - crying spells - loss of weight - poor sleep - social withdrawal - questioning meaning of life: Depressive thoughts, suicidal risk? What are the associated factors & social determinants? - employment & financial stress - Unemployment & impact on self worth & self confidence - Marital problem - Problems in relationship with son & parenting possibly

How do we provide support? Intervention: How do we approach TK? Critical self awareness & reflection Assumptions, biases, roles & boundaries “Listening” v.s. “Advising” What are the “pressing” needs/issues to be addressed? Should we address suicidal risks by “exploring openly”? “Working alone” or “Working in collaboration”- with whom? What goals are achievable & immediate? What are the positives? Working “with” v.s. working “for” the individual

Mental Health System

Key Legislations Related to Mental Health Balancing Rights & Choices to Treatment Safety of Self & Others Confidentiality Mental Health Legislations

Key Legislations Related to Mental Health Mental Health Act” “Involuntary Admission” “Health Care Consent Act” Personal Health Information Protection Act (PHIPA)

Introduction to the Mental Health System Continuum of Mental Health Related Services - Different Levels of Treatment Services & Community Resources: • Specialized Hospitals (Psychiatric Hospitals) • General Hospitals with psychiatric inpatient unit • Community Treatment Program (e.g. Assertive Community Treatment Team, Outpatient clinics) • Community Support Programs, e.g. case management, vocational support, supportive housing • Alternative Treatment Programs • Other community or social service programs, (e.g., settlement service, employment programs, educational / vocational programs)

Linkage to Mental Health & Addiction Resources CONNEX www.connexontario.ca Local CCAC 211 Local CMHA Only two ethno cultural specific community mental health organizations in the Toronto Region: Across Boundaries Hong Fook Mental Health Association www.hongfook.ca

Mental Health & Addiction Resources Crisis Service Gerstein Centre 416-929-5200 Scarborough Hospital Regional Mobile Crisis Program 416-289-2434 St. Elizabeth Health Care Integrated Community Mental Health Crisis Response Program 416-498-0043

Hong Fook’s Continuum of Services Framework

Get involved in the Health Care System! Cross-sector collaboration with others in our work Get informed and take part in giving your voice Learning and getting involved in LHIN (Local Health Integration Network (Reference: www.lhins.on.ca) Educate & Advocate for individuals we serve regarding their rights

JOURNEY TO PROMOTE MENTAL HEALTH An OCASI Staff Development Project 2008 - 2010

JOURNEY TO PROMOTE MENTAL HEALTH A partnership project with OCASI, funded by CIC An 18 month project providing cross sector knowledge exchange 2 day training series for front line settlement sector staff Goal is to raise awareness of mental health and to lower the stigma on mental illness Design of training series is geared towards the learning needs of the participants An Advisory Committee to provide guidance to the Project

Reflection for the Day… Feedback and Questions Thank you & Have a nice day! 60

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D7 Journey To Promote Mental Health: A workshop for Immigrant & Refugee Service Workers_Raymond C.Y.Chung & Maria Lo & Linda Yoo

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D7 Journey To Promote Mental Health: A workshop for Immigrant & Refugee Service Workers_Raymond C.Y.Chung & Maria Lo & Linda Yoo — Presentation Transcript