Speaking your language cacuss
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Speaking your Language was a project was a tri-institutional partnership between University of Toronto, OCAD University, and Ryerson University. We had a phenomenal working group of international educators, counsellors, and student life colleagues, and were joined by an even more phenomenal group of student volunteers. The intention of the collaboration between the schools was to combine our student populations as well as access to resources as our campuses are quite close.
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Speaking your language cacuss
- 2. Learning Outcomes 1. Recognize language international students use to talk about mental health 1. Recognize international student key challenges and perceptions towards mental health 2. Discuss opportunities and challenges in culturally/ linguistically-specific and counselling-centered approaches
- 3. 3 Phases of the Project 1. Student engagement and knowledge gathering 2. Implementation of models of support 3. Resource creation, dissemination of findings and recommendations
- 4. Homesickness Culture shock Language barriers Financial stress Food changes Getting sick Social or cultural isolation Cultural misunderstandings Educational system adjustments Staff/faculty unaware Discrimination No Canadian friends Housing
- 5. 2X Depressed 66% Overwhelmed 75% Stressed 81% Crisis appointments Psychiatric hospitalizations Suicidal ideation (Mitchell et al., 2007) (Speaking Your Language Survey)
- 6. The definition, cause, prevention, and treatment of mental health, is culturally defined
- 7. It’s not a mental health issue, It’s my life
- 8. In my country there are two categories of mental health insane fine
- 10. Open, continuous intake through Counselling centre Curriculum for students new to Canada Concerns about information “getting back home” Confidentiality forms
- 11. Benefits Hope Company Information sharing Social opportunities (Dipeolu et al., 2007)
- 12. Barriers Therapeutic vs social Ethical boundaries Therapist client relationship Priority is academics Confidentiality forms Audio taping (Dipeolu, 2007)
- 13. Literature Suggestions • Involve counsellors at events • Design group support as skills workshops or discussion groups • Market counselling services through videos or group tours • Create testimonials
- 14. • Hold information sessions later in term • Integrate with domestic students • Train peer mentors to support mental health • Extend an invitation Literature Suggestions
- 16. Students Suggested They lead Intentionally created supportive communities Activity based Informal, but with structure to encourage “real” conversations Professionals available Consistent relationships
- 18. Other Topics Academic Culture Academic Integrity Communications - class - professors - supervisors Health Resources Food Stress eating Body image Exercise Life Administration Skills Finances Immigration regulations
- 19. Preferred counselling language (Speaking Your Language Survey)
- 20. Highly recommended Leadership building Stress management
- 22. Trained peers Informal Staff invited Structured Life Academics Internat’l Peers Domestic students
- 24. References Dipeolu, A., Kang, J., Cooper, C. (2007). Support group for international students. Journal of College of Psychotherapy, 22(1), 63–74. Mitchell, S. L, Greenwood, A. K., & Guglielmi, M.C. (2007). Utilization of counseling services: Comparing international and U.S. College Students. Journal of College Counseling, 10, 117-129. Vigor, J. (2015), Speaking Your Language: Promoting Mental Health Awareness and Support for International Students University of Toronto, Ryerson University and OCAD University Partnership. Toronto, ON: Author
- 25. Discussion Approaches: A. Language-/culture-specific group counseling B. Drop-in themed discussion events C. Mental health promotion 1. Who could be involved (offices, staff, other)? What roles would they play? What strengths/assets would they bring to the project? 2. What challenges do you anticipate? (in planning, implementing, evaluating, etc.)
- 26. Contacts Abu Arif Project Co-ordinator / Co-ordinator of International Student Services Ryerson University arif.abu@ryerson.ca Nicole Kelly Committee Member / International Transition Advisor University of Toronto nicole.kelly@utoronto.ca
Editor's Notes
- Speaking your Language was a project generously funded by the Mental Health Innovation fund, through the Ministry of Training, Colleges and universities intended to learn more about how to address the unique mental health needs of our international students. The project was a tri-institutional partnership between University of Toronto, OCAD University, and Ryerson. We had a phenomenal working group of international educators, counsellors, and student life colleagues, and were joined by an even more phenomenal group of student volunteers. The intention of the collaboration between the schools was to combine our student populations as well as access to resources as our campuses are quite close. As I’m sure you can imagine there were a few challenges in navigating the administrative structures, memorandum of understandings, and resources of 3 large institutions. Today we will be highlighting some of the typical challenges that international students face and what models of support we have implemented between our three institutions based on student feedback and suggestions from the literature. Although we received funding for two years, by the time a joint job description and hire was completed, there were only 10 months left in the project, and we are so impressed with what our colleagues and students accomplished in this short time!
- By the end of this session our hope is that you will: In the first half we would be sharing information with you. In the second half we will be doing some group works to address the third learning outcome. 1. Recognize language international students use to talk about mental health, and consider incorporating this into your interactions with students 2. Recognize international student key challenges and perceptions towards mental health, identified by our research as well as international education and cross-cultural counselling literature 3. Discuss opportunities and challenges in culturally- or linguistically-specific, and counselling-centered approaches
- The project was divided into three main phases- Student engagement and knowledge gathering Implementation of models of support (counselling, group discussions, etc.) Resource creation and dissemination of findings and recommendations
- In the first phase, we gathered knowledge about international student experiences and perceptions towards mental health. We administered a survey and conducted one-on-one interviews with students, focus groups (in English, in Mandarin), and a literature review looking at international education and cross-cultural counselling research. In the following section I will be highlighting some of the findings and results of this knowledge gathering phase. Many of you will be familiar with the range of challenges and stressors that international students encounter, but since we have a very diverse audience of schools and roles, I’ll run through the list. As I read through, see if you can guess which three we heard the most about when we talked with our students? Surprisingly, three challenges that continuously came up were dealing with their 1) finances, 2) food changes, and 3) getting sick. These three stresses do make sense seeing as they all relate most to these students needing to take control of their own wellbeing. For many of these students (especially those between the ages of 18-25) this is their first time away from home. In terms of their finances – managing a budget may be new to them. Besides, not all international students are wealthy. Some come with only a year’s tuition, and then hope that they will qualify for scholarships and loans. Others initially have tuition, but their home country’s currency may devalue, leaving them short. And food changes can be shocking when students first move out on their own, trying to find healthy, familiar and comforting food. Even more stressful is trying to take care of yourself when you get sick and not knowing the details of Canadian health insurance, where to go to the doctor or even how to ask for extensions from professors when they are ill.
- From our survey (which had nearly 600 responses from across all three schools), we learned, “66% of students said they felt depressed at some point in the last year, 75% felt overwhelmed, and 81% felt stressed”. This self-assessment really does point to the lived reality of our students. The project was inspired by anecdotal need that international students don’t seek support until they are in crisis. Our team performed a literature review and quickly learned that this was well documented in over 30 years of research. One particular study from a large public university in the U.S. found that, out of all students who had used their counseling services, international student clients had twice as many crisis appointments, psychiatric hospitalizations, and suicidal ideation compared to domestic student clients. This points to the underutilization of mental health services until things get extremely challenging for these students. Across all the literature it is clear that international students are at heightened risk for mental health challenges, especially experiences of depression and anxiety. This seems to be mainly because students are in a time of extreme transition and may feel uncomfortable reaching out for the support they need. Students often focus the majority of their time on their studies and often lack social supports in Canada. When they feel that they are isolated in their challenges, that’s when the crisis can strike. The major challenge then is to get students to reach out to counselling services and other campus supports as a preventative measure and not as a last resort.
- In our survey 75% said they would seek help if they had a mental health problem. But when we started talking to the students, most said they would never even think of going to a counsellor. Instead we got comments like “I’m not crazy,” or “why would I talk to a stranger about my problems,” “what do you even do in counselling?” They don’t seek counselling partially because they want to be self-reliant, but also because counselling is a Canadian solution; and mental health is our language that they are often unfamiliar with. After all, the definition, cause, prevention, and treatment of mental health is entirely culturally defined. As one of our African students said, “I had never heard of depression before until I came to Canada. But I suppose we have a similar concept in my country: we call it thinking too much.”
- So all of this stress, anxiety, and depression that we see? Many international students don’t see it as a mental health issue. As one of our students put it, “It’s not a mental health issue, it’s just my life.” When we got talking to our students further, we heard a lot of reasons that they wouldn’t go to counselling: They didn’t know we have supports, what we do there, or that by paying tuition they are covered for the same services as domestic students under OHIP. They didn’t understand the acronyms, like CAPS, and thought it might refer to hats, instead of Counselling and Psychological Services. In fact, we heard about one student who couldn’t believe his health care was already paid for as part of his tuition. Instead, he’d send his parents, back in his home country, to the doctor with his symptoms, and then they’d mail him the medication they were prescribed. He did this for 3 years until one of his classmates convinced him, in fourth year, the he’d been paying for his healthcare all along. He could have been accessing health services throughout his entire time in Canada. We also heard that they were afraid of language or cultural barriers, that they didn’t want their friends to joke they were insane, or that they didn’t want to admit they had a problem. As one student from Russia put it:
- In my country, there are two categories of mental health- so insane that you are in the hospital, or fine. When we asked students “what does mental health and wellness mean to you from your cultural perspective?” we heard things like- “It’s worse than having cancer” “You must work on controlling yourself, it is your responsibility to get better” “It is seen as a weakness, and you’re often told to “toughen up” so I self-medicate at home” “People back home think there is too much emphasis placed on these issues in north America”- “If international students are diagnosed, their parents might consider it a “western thing” “China thinks it is your own fault and that you are not normal.” It was interesting to hear this Chinese perspective from our students since the majority of the research focuses on Asian students and the differences that arise between individuals raised in collectivistic societies and those from individualistic ones like Canada. From our research and student engagement, we noticed students from East Asian cultures stated they did not feel comfortable sharing their personal issues with someone outside of their immediate family or friend group. We also heard about cultural beliefs about counseling- “In Iran, we don’t share anything about our mental health and people are not comfortable going to a psychologist. We prefer to solve our problems at home with our family members.” “The available help (in China) is generally unprofessional and undependable. The psychotherapist license is very easy to get and psychologists don’t have a good reputation. My mother said that a psychologist doesn’t respect a patient’s privacy and that if they treat you successfully they will open your file to the public to prove that they helped you recover.”
- Given the lack of openness towards mental health in many cultures, it wasn’t surprising international students lacked basic mental health literacy that we take for granted in Canada. One of our students said, “I was making myself throw up all of the time, and I knew that something was wrong, but I didn’t know what it was or what it was called. It was very hard to tell my parents, and they told me I should work on controlling myself and I shouldn’t talk about it.“ International students are also more likely to report having physical ailments than to having a problem with their mental health. Psychologists call this physical manifestation of psychological distress somatization, and for many of our students, it makes sense for them to present with physical pain – especially if it isn’t culturally acceptable to develop a mental illness. Plus, it would be far more culturally acceptable to go to a doctor for a physical ailment than to an identified mental health professional. It is important to be aware that students who might be complaining of stomach aches, headaches, gastro-intestinal problems, or problems with their eating could have underlying psychological distress. However, these students may not be aware of this being related to their mental wellbeing which creates additional challenges.
- So, given all of these student pressures and barriers in seeking support, what were to try? Given that we were on tight timelines, we ran an already planned multi-cultural counselling group with curriculum addressing issues for students new to Canada, but as soon the students saw confidentiality forms, they wanted nothing to do with it. It was too formal.
- As we’ve already mentioned, generally speaking, international students have a negative view of individual counselling services, but it’s important to note that the literature is supportive of group counselling as the main intervention for this population. Researchers agree that the group offers advantages over individual counselling because groups can instil hope, modify feelings of being alone, impart information, assist students to feel needed and useful and can help develop socializing tools and group cohesion. In every way, group counselling seems to be an ideal setting for students to gather and discuss their normal challenges. A 2007 study even had international graduate students facilitate the group counselling sessions so that the facilitators felt more like collaborators and less like evaluators. But still, the author maintained that international students are likely to view the following things as barriers.
- Counsellors understandably come in with a therapeutic agenda, whereas the students, who often want more to connect with others about their similar experiences, expect more of a social gathering and this makes it difficult to keep the discussion on track. Not explaining the ethical boundaries of the therapist and client relationship can also unintentionally further stigmatize the students’ experience. I came across an anecdote in the research that speaks to this. A student ran into their counsellor at the grocery store and felt very confused when the counsellor wasn’t as friendly as they had expected. To them, this was a person with whom they’d shared some extremely intimate experiences so they couldn’t understand why this person was acting so distant. Of course the counsellor was simply abiding by their own ethical boundaries but the student didn’t know that and felt ignored. It’s also hard for students to justify taking an hour out of their academic week to attend a counselling group. It simply isn’t a priority for them. Although the research does suggest that international students are more likely to reach out for help around highly stressful periods like exam time. This can be problematic though since that’s when all students are reaching out for help and the access to services is nearly impossible due to long wait times. And of course, not explaining confidentiality forms properly, taping or recording the sessions are all jarring to international students. Embellish about confidentiality forms.
- Researchers believe that involving counsellors at events in an informal capacity is a more appealing way to make first introductions. This way, students can establish personal contact, learn about their roles and functions and can gain an understanding about help seeking and about campus resources. They suggest that support groups are designed as skills workshops or discussion groups to avoid the intimidating language of “therapy” and “counselling” that students might not be comfortable with yet. We should market our counselling services through videos or group tours using student testimonials. We’ve created a video based on this suggestion that you can view today as we have attached it to this webinar as a resource.
- The first point on this slide makes a lot of sense. We should be hosting information sessions about mental health and other support services on campus later on in the year when students aren’t as overwhelmed with all the information they receive during their first month of orientation. Integrating domestic students in your support programs is vital because almost all international students go abroad hoping to engage with the culture they’re living in. Most international students we spoke to expressed that they wanted more Canadian friends. To this point, it is important to include peer mentors in the discussion. We know from the research that students are more likely to seek help from counselling services if they know that a friend has sought help in the past and had a positive experience. A lot of international support offices are already organizing outreach events and use peer mentor teams because upper year students are in the best position to act as student ambassadors. What peer mentors need is to be trained in recognizing the normal mental health issues that international students face. When training our peer mentors we made sure to break down the basics of culture and how it can influence a person’s understanding of mental health before highlighting some of the most common challenges. Most people are not aware of other people’s cultural perspectives and often are not even fully aware of the existence of their own. And finally, extend an invitation. Make the conversation about mental health engaging and invite students to explore the various supports that your campus offers.
- It’s been suggested that international students are more likely to respond to a referral to counselling that feels like an invitation, so we created exactly that. On one side, it looks like a party invitation, something unassuming that could hang on your fridge. On the back, a list of things that a student might want to talk about with someone. And at the bottom there’s some space to include contact information and locations and most importantly, there’s a space for you to personalize it with their name. We hope that a resource like this might be used to spark a conversation between staff and students about their wellbeing in a way that is non-threatening and illuminates the reality of counselling services. - Posters
- What we were hearing from students and reading in the literature is that students want a supportive community, one that comes together to create structured events around important topics. Events that have professionals in attendance so could meet them in person, form relationships, and ask questions without feeling ashamed of walking through the counselling office’s doors. Taking these suggestions into consideration, we decided to create two separate projects to see which would be most effective. The first, an informal student led discussion event series.
- And, as suggested by the literature, the students chose what kind of experts they’d like to have present and then invited various professionals to contribute to the conversations. This way, students felt more comfortable accessing support services like counseling because the initial interaction was in an informal and non-threatening setting. Oh, and we always served free lunch. Self-love: Professional: Family: Friends: Partners:
- Classroom culture and expectations Academic integrity How to talk in class Emailing professors Dealing with supervisors Finances and Visas.
- When we asked students about preferred counselling language: 65% said English 10% Mandarin and so, after we did a language and cultural background survey amongst our counsellors to determine that we did not have a Mandarin speaking counsellor available, sought an expert in East and South East Asian communities as a partner, Hong Fook Mental Health Association.
- Understandably, research suggests that students might feel more comfortable expressing themselves in their native language. So, with the help of our community partner, Hong Fook Mental Health Association, we organized an 8 week Mandarin speaking counselling group. We’ve also worked with the staff from Hong Fook to arrange for cultural competency trainings for our staff and counsellors. We are going to do a quick poll now, so please let us know if you have language based counselling on your campus. While this counselling group does not require that students sign a confidentiality form, we did ask that they email or call ahead of time to let us know they’d be attending. This turned out to be a barrier we hadn’t expected. It wasn’t until the 4th week that we had 5 students attend the session and this was a big success for us. As we suspected, this group was much more difficult to market. We held a Mandarin focus group and learned that while students would appreciate this type of group they might feel embarrassed to tell their Chinese friends that they’ve attended. The reason, students said, was that if other people knew they had a mental health issue they might be labeled as a psycho. If they listen to other sad students, it might make them sadder and sicker. We took into consideration that our Chinese students told us that they would respond well to something marketed as a skill building session or if it came highly recommended from their international office or faculty. We also knew to stay away from the word “therapy” and instead used words like “leadership building” and “stress management” when marketing on social media. Some things that were surprising to us about this group were that students did not want to speak in Mandarin and preferred to speak to each other and their Chinese facilitators in English. Sitting in on the group, I noticed that mental health was never spoken about directly and the word stress was used to fill in for almost every negative emotion. These students did tend to look to their facilitators for problem solving skills and considered them to be the experts on their wellbeing even when they were told that they themselves know best.
- To further disseminate the knowledge we’ve gathered, we hosted a Speaking Your Language symposium on February 20th of this year. Our attendance of 176 professionals from 6 provinces and across 30 academic institutions indicated that clearly this is a complex and important topic that professionals across Canada are eager to explore. The symposium not only gave us a chance to share our experiences with our tri-institutional international student population but also allowed for our colleagues to highlight the innovative projects that exists on campuses across the country. There is so much inspiring work being done and we hope that the symposium allowed for focused dialogue about the real stressors that our international students are facing.
- What we learned is international students wanted a balance. They wanted the support and experience of upper year international peers, but they also wanted to meet Canadian students. The peer mentors wanted training so they knew what to do if someone had a mental health challenge, but they wanted staff available for if there were situations or questions they didn’t know how to handle. They wanted informal events, but with enough structure to provide them the space to talk about important, meaningful topics. Academics are always the priority, but you can infuse mental health care into those, and provide information on how to handle the rest of their life.
- We learned that it’s important to give enough time to plan and implement, and it’s important to set up partnerships early, and clarify what those roles are. It’s always important to assess risk and legal liability, and to provide training and support to those involved. And finally it has to be fun and fun. I’m excited to see partnerships between International Student Services, Counselling, and Academic Supports as we move forward, and I’m excited to see how our international students will continue to contribute to our community. I wanted to say an enormous thank you to the students and staff who have supported in this project in so many ways. Thank you
- Approaches: A. Language-/culture-specific group counseling B. Drop-in themed discussion group C. Mental health promotion Groups of 4. Discuss for 10 minutes, then share back with larger group, draw out common themes, talk about strategies to overcome challenges.