The human connection

More than 800 government-assisted refugees are expected in London by the end of February, and by the end of the federal government process, more than 36,000 are expected to arrive across Canada.

At first glance, accepting refugees seems like a complicated process, but ultimately a hopeful one for refugees. Individuals and families fleeing a war-torn region are accepted into the welcoming arms of a peaceful country. However, when refugees arrive in cities like London, they face additional challenges, from language, culture and employment, to dealing with physical and mental health issues.

Two researchers from Schulich School of Medicine & Dentistry are looking at the system to understand what refugees really face when they arrive in their new homes, bringing attention to ways that frontline health care providers, organizations and governments can make the transition easier.

Kelly Anderson, PhD, is an assistant professor in the Departments of Epidemiology and Biostatistics, and Psychiatry. In a paper released in 2015, she took a population-level view of the high incidence of psychosis in some first-generation refugee populations.

Her interest began with a similar phenomenon initially observed in Europe. A meta-analysis of these studies found the risk of psychosis was two to three times higher in migrant populations, compared with the general population. Anderson wanted to know if this was also happening in Canada.

Anderson’s research examined a 10-year window of data from 4.3 million people across Ontario, including first-generation immigrants and refugees, looking at the incidence of schizophrenia and schizoaffective disorders.

Higher rates of psychotic disorders were found amongst immigrants from the Caribbean and Bermuda – 60 per cent higher than the general population – with lower rates found in immigrants from northern Europe, southern Europe and East Asia. Being a refugee from any country was a significant predictor of risk, with the highest rates in people from East Africa and South Asia —95 per cent and 51 per cent higher, respectively.

How being a refugee impacts mental illness is a nuanced issue, according to Anderson. Every step along the way can have an impact – from the conditions of the country of origin and the method of travel to the new country, to the circumstances they face when they arrive in their new homes.

“We have really good evidence that the conditions refugees arrive into, such as a supportive environment, secure housing and employment opportunities, can help mitigate some of the adverse mental health outcomes,” said Anderson.

Researchers are also taking a look at the system from the inside, with a focus on adapting the system to better meet the needs of the refugees who are arriving daily. Lloy Wylie, PhD, is an assistant professor in the Departments of Psychiatry and Pathology, and with the Schulich Interfaculty Program in Public Health. Her research into health systems looks at challenges faced by vulnerable and underserved populations, with a specific focus on Indigenous people, immigrants and refugees.

“We’re seeing a higher level of trauma with refugees than ever before, because they’ve experienced torture and war,” said Wylie. “Due to the lack of coordination between the many service providers needed for refugees, we’re asking people totell us their stories again and again, re-traumatizing them.” That “re-traumatization” makes it difficult for refugees to move past their trauma and into a therapeutic relationship with their health care provider.

Wylie also notes that in most instances hospitals are not necessarily the best place for refugees coming from traumatic backgrounds. Hospitals can be cold and institutional, and having mental health services located there can be a barrier to a population who may not trust the hospital system. In addition, many cultures view mental illness as a stigma they want to avoid.

Community-based organizations may be a better location for providing mental wellness services that address a range of stresses facing new refugees. To address these access barriers, Wylie is working with community partners, such as the Cross Cultural Learner Centre (CCLC) and local hospitals, to develop a cross-cultural, trauma informed mental health service that will provide care in a safe, community environment.

Like Anderson, Wylie identifies the stresses associated with transition as an issue that can contribute to mental illness. “Often what we see is that the stresses are coming from a number of places,” said Wylie, “Being unemployed, overwhelmed by the amount of paperwork, or isolated can lead to depression. Strictly clinical approaches don’t address those challenges, but there are social solutions.”

There is no black-and-white guide for how to work with refugees, but Wylie has advice for anyone who wants to make a difference for a newcomer to Canada. “Health care and service providers, researchers and citizens – we all need to be a human connection for refugees,” said Wylie. “Find out what is important to them, rather than making assumptions. Often we see refugees as helpless and in need, not acknowledging their resilience and fortitude. The people who come here have real skills to contribute. We need to recognize the strength they bring. That acknowledgement and validation is key to supporting mental wellness among newcomers.”