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Immigration and Mental Health


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Title: Immigration and Mental Health

Immigration and Mental Health
Armchair Discussions Canadian School of Public
Service Ottawa 28 February 2008
  • Nazilla Khanlou, RN, PhD1
  • 1 Health Wellbeing Domain Leader , CERIS The
    Ontario Metropolis Centre
  • Associate Professor, LSB Faculty of Nursing
    Department of Psychiatry, University of Toronto

  • Context (Immigrant population, Newcomer youth)
  • Mental health (What is it?, Healthy immigrant
  • Resilience (Why is it important for mental
  • Research example
  • Discussion

  • Immigrant Population
  • Newcomer Youth

Immigration 2006 Census
  • Over 6 million foreign-born (close to 20 of
    population) highest proportion in 75 years
  • Between 2001-2006, over 1 million immigrants to
  • Approximately 60 of newcomers from Asia
    (compared to 12 in 1971), 16 from Europe (62
    in 1971), 11 from Central and South America, and
    11 from Africa
  • Over 70 of foreign-born mother-tongue other than
    English or French (over 18 Chinese, over 6
  • Close to 70 of recent immigrants in Toronto,
    Montreal and Vancouver
  • Most foreign-born (85) eligible for Canadian
    citizenship, naturalized
  • Note Numbers above have been rounded.
  • Statistics Canada. (2007). 2006 Census
    Immigration, citizenship, language, mobility and
    migration. The Daily 4 December 2007.
    Available URL http//

Newcomer Youth
  • Children and youth make up a significant portion
    of immigrants into Canada
  • Over last decade (1997-2006)
  • 0 to 14 years (over 20 each year)
  • 15 to 24 years (over 13 each year)
  • In 2006
  • 0-14 years/2006 51,320 (20.4 of 251,649)
  • 15-24 years/2006 40,674 (16.2 of 251, 649)
  • Citizenship and Immigration Canada. (2007).
    Facts and Figures 2006. Immigration Overview
    Permanent and Temporary Residents 2006.
    Available URL http//

Mental Health
  • What is it?
  • Healthy immigrant effect

Mental Health
  • Without mental health there is no health
  • More than the absence of mental disorders
  • a state of well-being in which the individual
    realizes his or her own abilities, can cope with
    the normal stresses of life, can work
    productively and fruitfully, and is able to make
    a contribution to his or her community
  • Determined by socio-economic and environmental
  • Linked to behaviour
  • World Health Organization. (2007). Mental
    health Strengthening mental health promotion.
    Fact Sheet 220. Available URL

Mental Health Promotion
  • ... the process of enhancing the capacity of
    individuals and communities to take control over
    their lives and improve their mental health.
    Mental Health Promotion uses strategies that
    foster supportive environments and individual
    resilience, while showing respect for culture,
    equity, social justice, interconnections and
    personal dignity.
  • Centre for Health Promotion. (1997).
    Proceedings from the International Workshop on
    Mental Health Promotion. University of Toronto.
    In C. Willinsky, B. Pape. (1997). Mental
    health promotion. Social Action Series.
    Toronto Canadian Mental Health Association
    National Office.

Theoretical Perspectives
  • Approaches to examining immigrant health
  • 1. Morbidity-mortality hypothesis
  • 2. Healthy immigrant effect
  • 3. Transitional effect

Alati, R., Najman, J.M., Shuttlewood, G.J.,
Williams, G.M., Bor, W. (2003). Changes in
mental health status amongst children of migrants
to Australia a longitudinal study. Sociology of
Health and Illness, 25(7), 866-888. --------------
------------------------------------------------ F
or a critique of sick immigrant and healthy
immigrant paradigms see Beiser, M. (2005). The
health of immigrants and refugees in Canada.
Canadian Journal of Public Health, 96(Supplement
2), S30-S44.
Healthy Immigrant Effect
  • 2000/01 Canadian Community Health Survey
  • Immigrants lower rates of depression and alcohol
    dependence than Canadian-born
  • Healthy immigrant effect strongest among recent
    immigrants and immigrants from Africa and Asia
    (most recent immigrants from Asia and Africa)
  • Long term immigrants similar rates of depression
    as Canadian-born (most long term immigrants from
  • Findings consistent with those on physical health
    (immigrants in better physical health than
  • Ali. J. (2002). Mental Health of Canadas
    Immigrants. Supplement to Health Reports, volume
    13, Statistics Canada, Catalogue 82-003, 1-11.

Healthy Immigrant Effect
  • Although it is clear that there are
    vulnerable sub-groups among immigrants, it
    appears that most immigrants, particularly recent
    immigrants, exhibit fewer mental health problems
    than the Canadian-born population. Whether this
    pattern reflects greater resiliency or a
    difference in how immigrants approach stress and
    adversity in their lives is a question that could
    be addressed in future research. (Ali, 2002, p.
  • Ali. J. (2002). Mental Health of Canadas
    Immigrants. Supplement to Health Reports, volume
    13, Statistics Canada, Catalogue 82-003, 1-11.

Newcomer Youth
  • Important to distinguish between status
  • Immigrant
  • Refugee
  • Precarious status
  • Also helpful to distinguish between phases
  • Pre-migration
  • Migration
  • Post-migration
  • Khanlou, N. (2007). Young and new to Canada
    Promoting the mental wellbeing of immigrant and
    refugee female youth. International Journal of
    Mental Health Addiction. (Online
  • Khanlou, N., Guruge G. (2008). Chapter 10
    Refugee youth, gender and identity On the
    margins of mental health promotion. In
    Hajdukowski-Ahmed M, Khanlou N, Moussa H
    (Editors) Not born a refugee woman Contesting
    identities, rethinking practices. Oxford/New
    York Berghahn Books (Forced Migration Series).

Mental Health Mental Health PromotionImmigrant
receiving and multicultural societies
  • Mental health a sense of mental well-being
    arising from interaction between individual and
    environment. Intersections of micro (e.g. health
    status, social networks) and macro (e.g.
    neighbourhoods, political instability,
    globalization) level influences.
  • Intersections of gender, life stage, cultural,
    migrant and racialized status on mental health
    promotion in multicultural settings must be
  • Khanlou, N. (2003). Mental health promotion
    education in multicultural settings. Nurse
    Education Today, 23(2), 96-103.
  • Khanlou, N., Beiser, M., Cole, E., Freire, M.,
    Hyman, I., Kilbride, K.M. (2002). Mental health
    promotion among newcomer female youth
    Post-migration experiences and self-esteem.
    Ottawa Status of Women Canada.

  • Why is it important for mental health?

Defining Resilience
  • Capacity to cope with, and bounce back after,
    the ongoing demands and challenges of life, and
    to learn from them in a positive way (Joubert
    Raeburn, 1998)
  • Positive adaptation to adversity not the absence
    of vulnerability (Waller, 2001)
  • Is a class of phenomena characterized by good
    outcomes in spite of serious threats to
    adaptation or development (Masten, 2001)
  • Joubart, N., Raeburn, J. (1998). Mental health
    promotion People, power and passion.
    International Journal of Mental Health Promotion,
    Inaugural issue, September, 15-22.
  • Masten, A. S. (2001). Ordinary magic
    Resilience processes in development. American
    Psychologist, 56(3), 227-238.
  • Waller, M.A. (2001). Resilience in ecosystemic
    context Evolution of the concept. American
    Journal of Orthopsychiatry, 71(3), 290-297.

Growing Up Resilient Ways to Build Resilience in
Children and YouthBarankin, T., Khanlou, N.
(2007). Toronto CAMH (Centre for Addiction and
Mental Health).
Systems involved
  • Individual
  • Family
  • Environment
  • Barankin Khanlou (2007)

Environmental Factors
  • Inclusion
  • Having a sense of belonging
  • Gender
  • Culture
  • Social conditions
  • Society promoting resilience
  • Socio-economic situation
  • Media influences
  • Barankin Khanlou (2007)

Environmental Factors (continued)
  • Access
  • Systems promoting resilience
  • Education
  • Health
  • Involvement
  • Youths participation in the world around them
  • Barankin Khanlou (2007)

Environmental examples of protective factors
  • Policies (local to national) promoting equity,
    justice, inclusion
  • Access to community resources (e.g. public
  • Supportive and safe school environments
  • Living in a safe and caring neighbourhood
  • Access to counsellors mental health addiction
    services as needed
  • Positive media messages
  • Contact with caring adults (e.g. teachers,
    coaches, etc)
  • Links to strong cultural community (sense of
    history, feelings of belonging)
  • Involvement in healthy physical, recreational,
    and volunteer activities
  • Barankin Khanlou (2007)

Putting it all together
  • Resilience is developed within the context of
    multiple systems.

Research example
  • Newcomer Youth

Newcomer Youth Study Khanlou, N., Beiser, M.,
Cole, E., Freire, M., Hyman, I., Kilbride, K.M.
(2002). Mental health promotion among newcomer
female youth Post-migration experiences and
self-esteem/ Promotion de la santé mentale des
jeunes immigrantes Expériences et estime de soi
post-migratoires. Ottawa Status of Women Canada .
Self-concept Khanlou, N., Crawford, C.
(2006). Post-migratory experiences of newcomer
female youth Self-esteem and identity
development. Journal of Immigrant and Minority
Health, 8(1),45-56. Figure 1 Self-concept
theme and sub-themes, p. 50
  • Friends
  • Ya, because we are still ESL students, sometimes
    we cant speak English very well, and then, those
    maybe Canadian born or those English speakers
    dont really talk to us, sometimes, but they do
    but not much. (P2, FG1)

Systems issues
  • She feels different because in certain
    occasion children make her feel different. You
    know, her hair is different of course, her colour
    is different than other children, and she had an
    accent, but she doesnt have the accent now, ya,
    but she had an accent. And you know, and always
    being asked where do you come from? (PA3, PI2)

Systems issues
  • Because, I mean if you, you think if kids come
    with parents who are doctors and nurses and they
    come here. Parents have to end up in factory,
    theyre frustrated, that frustration is passed on
    to the children as well. (S2, Meeting with SEPT

Key Findings
  • Important role of gender in settlement
    experiences of newcomer immigrant youth.
  • Language barriers significantly influenced
    different aspects of youths lives (e.g. school
    outcomes, peer relationships).
  • Discriminatory attitudes and family settlement
    barriers can impact youths mental health.
  • Despite challenges, youth had positive outlook on
    their future and high motivation for educational
    and career success.
  • 15 policy recommendations made addressing
    education system, health and social services
    systems, resettlement services, and

Policy Recommendations Health Social Services
  • Educate health social services professionals
    working with newcomer female youth in cultural
  • Across the health system, provide appropriate MHP
    initiatives for newcomer female youth.
  • Focus on strengths of newcomer female youth as
    well as their challenges. Foster youth
    participation in decision-making fora related to
    health social services planning.

Policy recommendations Across Systems
  • Develop and co-ordinate partnerships (including
    health, education, social and resettlement
    services) across systems.
  • Adopt culturally sensitive, anti-discriminatory
    policies and strategies in institutions that work
    with newcomer female youth and their families.

  • Thank you!

Contact Information
  • Nazilla Khanlou
  • CERIS The Ontario Metropolis Centre
  • University of Toronto