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. 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. 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. What makes
someone healthy?

5. Most people think that our health
is dependent on…

6. Some even think of “lifestyle”…

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

9. 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

10. 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

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

12. 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.

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

14. 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- she appears to be passive, submissive, withdrawn and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

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

17. 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)

18. 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?

19. Mental Health & Mental Illnesses:
A Cultural Competence Framework

20. Cultural Competence

21. 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)

22. 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
.

23. 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).

24. 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.

25. 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

26. Warm up activities!!!!

27. 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

28. 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

29. 15 minutes Break

30. 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

31. Mental Health as a Continuum
Wellness Illness

32. 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.

33. 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

34. 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

35. 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.

36. 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

37. 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)

38. 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

39. So What do we do with this
knowledge?

41. MENTAL ILLNESS IS TREATABLE
RECOVERY IS POSSIBLE!

42. 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

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

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

45. 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

46. 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

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

48. 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

49. 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

50. Mental Health System

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

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

53. 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)

54. 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

55. 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

56. Hong Fook’s Continuum of Services
Framework

57. 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

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

59. 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

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