Journey to Promote Mental Health:
A Workshop for Community Workers
 Serving Ethno-racial Communities



       Hong Fook M...
Goals

To heighten Participants’ awareness of the
interconnectedness between Mental Health
and Settlement Services

To enh...
Outline
•   Welcome & Introduction
•   Holistic Health & Migration
•   Cultural Competence
•   Stigma & Mental Health

   ...
What makes
someone healthy?
Most people think that our health
is dependent on…
Some even think of “lifestyle”…
Employment
            Income    Education             Healthy Child
                                            Developme...
Factors Affecting our
     Mental Health and that are
Particularly Important to Immigrants

  Income and social status
  S...
Spirit
                                                                    MUTUAL
UNDERSTANDING                           ...
What needs to be addressed in
promoting mental health beyond the
        individual factors?
Health Disparities Result From…
        Biological/
         Genetic
Individual
        Lifestyles                        ...
Identifying the Stressors Associated With
          the Migration Process


        Case Example:
    Can you name stresso...
Case Example
- Ling is a 20 yrs old new immigrant who came from China
  2 years ago with her mother
- Ling is unemployed a...
Question:

If you are the settlement worker serving Ling,
what are the stressors in her circumstances that
you would atten...
Identifying the Stressors Associated With
            the Migration Process
Chronic Stress has been linked to the 6 leadin...
Moving Beyond Information Services

          What could we do?
   as a frontline settlement worker……..
as an organization...
Mental Health & Mental Illnesses:
A Cultural Competence Framework
Cultural Competence
Othe



                                                      der
                                                   Gen
 ...
While we may acknowledge diversity, we must also
       acknowledge that inequities and oppressions exist…


             ...
Definition of Cultural Competence

“ A set of congruent behaviours, attitudes and
  policies that come together in a syste...
Am I culturally competent if I …

 tell my Chinese client that I am Chinese too and an
 immigrant also, so I know what she...
Key Points

                   Interpretation of                   Critical Self
                    culture by the       ...
Warm up activities!!!!
How do we see mental health & mental illness?
 Statement #1:
 People with mental illness are violent and dangerous
 Statem...
Stigma & Mental Illness

 Stigma relates to:
   Misconception of mental illness
   Lack of knowledge
   Discomfort with di...
15 minutes Break
What is Mental Health?

 Mental health is about striking a balance in
 the physical, mental, spiritual, social and
 econom...
Mental Health as a Continuum




Wellness                           Illness
The 4 Ps of Mental Health

• Precipitating factors: triggered by stressful
  events.
• Predisposing factors: things that m...
Some Early signs and symptoms of mental
health issues (not a check list or an exhaustive list)

• Physical fatigue and low...
Other Common Symptoms
•   Increased irritability & anxiety
•   Racing thoughts
•   Poor concentration
•   Anger
•   Feelin...
WHAT IS MENTAL ILLNESS?

 Mental illness is a medical condition that
 affects an individual’s thinking, mood and
 behaviou...
Different Types of Mental Illnesses

 Psychotic Disorders
 Examples: Schizophrenia, Delusional Disorder
 Mood Disorders
 E...
How common are Mental Illness & Addiction
         Issues in Canada?
 • 1 in 10 (aged 15 and over) – 2.7 million have
   s...
Other Statistics & Facts
(Source: Mood Disorder Society of Canada)
  Chances of having a mental illness in your lifetime i...
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...
Any symptoms that we detect in JJ that
          are of concerns?
Treatment Approaches
   Psychiatric Medication
            ECT
           ACTT
       Psychotherapy
   Alternative Treatme...
What can we do in dealing with mental
         health challenges?

 Early Identification
 Understand associated factors an...
Case Scenario: How do we provide support?
 •   TK is a 35-year old female
 •   Immigrated to Toronto 2 years ago from Main...
Case Scenario: How do we provide support?



 What is our assessment of his needs & areas
 to work on?

 How do we interve...
How do we provide support?
Questions to ask:
Assessment
Early Identification: What are the signs of mental health issues?
...
How do we provide support?
Intervention: How do we approach TK?
  Critical self awareness & reflection
  Assumptions, bias...
Mental Health System
Key Legislations Related to Mental Health

               Balancing

      Rights & Choices to Treatment
          Safety ...
Key Legislations Related to Mental Health

           Mental Health Act”

        “Involuntary Admission”

       “Health ...
Introduction to the Mental Health System
   Continuum of Mental Health Related Services -
                   Different Lev...
Linkage to Mental Health & Addiction
            Resources

                  CONNEX
            www.connexontario.ca
    ...
Mental Health & Addiction Resources

 Crisis Service
 Gerstein Centre 416-929-5200

 Scarborough Hospital Regional Mobile ...
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 i...
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 se...
Reflection for the Day…
 Feedback and Questions
Thank you & Have a nice day!




                               60
D7 Journey To Promote Mental Health:  A workshop for Immigrant & Refugee Service Workers_Raymond C.Y.Chung & Maria Lo & Li...
D7 Journey To Promote Mental Health:  A workshop for Immigrant & Refugee Service Workers_Raymond C.Y.Chung & Maria Lo & Li...
D7 Journey To Promote Mental Health:  A workshop for Immigrant & Refugee Service Workers_Raymond C.Y.Chung & Maria Lo & Li...
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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

  1. 1. 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
  2. 2. 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
  3. 3. 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
  4. 4. What makes someone healthy?
  5. 5. Most people think that our health is dependent on…
  6. 6. Some even think of “lifestyle”…
  7. 7. Employment Income Education Healthy Child Development Social Inclusion Social Determinants of Health Housing Food Safe Physical Health/Social Transportation Environment Services .
  8. 8. 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
  9. 9. 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
  10. 10. What needs to be addressed in promoting mental health beyond the individual factors?
  11. 11. 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.
  12. 12. Identifying the Stressors Associated With the Migration Process Case Example: Can you name stressors immigrants and refugees may face?
  13. 13. 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
  14. 14. Question: If you are the settlement worker serving Ling, what are the stressors in her circumstances that you would attend to in supporting her?
  15. 15. 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)
  16. 16. 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?
  17. 17. Mental Health & Mental Illnesses: A Cultural Competence Framework
  18. 18. Cultural Competence
  19. 19. 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)
  20. 20. 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 .
  21. 21. 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).
  22. 22. 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.
  23. 23. 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
  24. 24. Warm up activities!!!!
  25. 25. 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
  26. 26. 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
  27. 27. 15 minutes Break
  28. 28. 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
  29. 29. Mental Health as a Continuum Wellness Illness
  30. 30. 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.
  31. 31. 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
  32. 32. 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
  33. 33. 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.
  34. 34. 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
  35. 35. 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)
  36. 36. 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
  37. 37. So What do we do with this knowledge?
  38. 38. MENTAL ILLNESS IS TREATABLE RECOVERY IS POSSIBLE!
  39. 39. 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
  40. 40. Any symptoms that we detect in JJ that are of concerns?
  41. 41. Treatment Approaches Psychiatric Medication ECT ACTT Psychotherapy Alternative Treatment Psychosocial Support Group Day Program Vocational program Peer Support Case Management Other Community Support
  42. 42. 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
  43. 43. 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
  44. 44. Case Scenario: How do we provide support? What is our assessment of his needs & areas to work on? How do we intervene?
  45. 45. 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
  46. 46. 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
  47. 47. Mental Health System
  48. 48. Key Legislations Related to Mental Health Balancing Rights & Choices to Treatment Safety of Self & Others Confidentiality Mental Health Legislations
  49. 49. Key Legislations Related to Mental Health Mental Health Act” “Involuntary Admission” “Health Care Consent Act” Personal Health Information Protection Act (PHIPA)
  50. 50. 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)
  51. 51. 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
  52. 52. 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
  53. 53. Hong Fook’s Continuum of Services Framework
  54. 54. 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
  55. 55. JOURNEY TO PROMOTE MENTAL HEALTH An OCASI Staff Development Project 2008 - 2010
  56. 56. 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
  57. 57. Reflection for the Day… Feedback and Questions Thank you & Have a nice day! 60
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