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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Improving Services for Multicultural Clients

Mental Health Commission of Canada Recommendations

Judith Ince

Reprinted from the "Immigrants and Refugees" issue of Visions Journal, 2010, 6 (3), p. 7

Immigrants and refugees arrive in Canada with bright hopes, yet these are often dimmed by hardships here.

The Mental Health Commission of Canada (MHCC) has studied the mental health of multicultural communities. The MHCC report title, Improving Mental Health Services for Immigrant, Refugee, Ethno-cultural and Racialized Groups: Issues and Options for Service Improvement,1 indicates the four multicultural groups addressed in the study.

In addition to immigrants and refugees, MHCC includes people bound by the common customs, beliefs and ancestry of an “ethnocultural” community. The study also includes “racialized” Canadians; that is, those who are deemed to belong to a specific race. The ethnocultural and racialized groups have been in Canada for a longer time than the immigrant and refugee groups.


This new study considered a wide body of research, and held focus groups with members of multicultural groups. These communities face many social conditions that undermine their emotional well-being. Unemployment, job insecurity, low-status jobs and poverty are common, even though these people are well educated. Their university graduation rates are more than twice the Canadian average, and these university grads hold half of all doctoral degrees in the country.

Researchers found that the some parts of these populations have more serious emotional problems than others. Not surprisingly, immigrants and refugees who have fled wars or natural disasters are at very high risk for suicide, depression and anxiety disorders.

Mental health problems are also especially common among racial minorities, second-generation Canadians and older adults. Racial discrimination is a daily stressor for many members of visible minorities, and can contribute to mental health problems such as depression. For reasons not entirely understood, the offspring of immigrants have higher rates of depression, illicit drug use and alcohol abuse than their parents.

Elderly members of immigrant, refugee, ethnocultural and racialized populations face unique difficulties, including high rates of poverty, which is a risk for poor mental health. Those who come to Canada late in life face particular hardship. Learning a new language, adapting to a different culture and establishing new social connections heavily tax their emotional resources. While many elders live with their children and grandchildren, the assistance and support they receive is offset by the isolation they experience while the younger generations are at work or school.

A number of barriers block immigrant, visible minorities, refugees and ethnocultural groups from getting the mental health care they need. Some studies suggest that some members of these groups believe that mainstream mental health care is unlikely to respect their values and cultural expectations. Language barriers are also believed to deter these communities from asking for help. In addition, some parts of these communities believe that they are likely to be offered lower quality of care than other Canadians because of institutionalized discrimination against them. Mental illness carries a stigma among many, and some fear that seeking treatment will bring shame on themselves and their families.

When immigrants, refugees, ethnocultural or racialized Canadians do decide to seek treatment, poverty can get in the way. Marginal or unstable employment makes it difficult to book appointments with mental health professionals, and expensive psychiatric medications are often beyond their financial reach.

“I think old people are more at risk of mental health problems, because they are alone and cannot take care of themselves properly.” –focus group participant1


The MHCC study recommends three linked approaches to better serve these groups. First, it urges all levels of government to coordinate policy and services among themselves, as well as with the private and non-profit sectors. At present, there are any number of agencies providing similar services to the same communities. Without planning and coordination, however, services are often duplicated and inefficiently delivered. Any new mental health strategy also needs to include a way of measuring how well it meets its goals.

Developing policies to guide the creation, delivery and assessment of mental health services requires much expertise. The report recommends that a national panel of experts—academics as well as members of the communities served—work together on these issues. For example, close monitoring of, and research into, the aging of the ethnocultural population will help prepare for the demand on psychiatric services that are expected over the next two decades as the size of the aging population grows. Such information could be then shared via the Internet, so that the experts’ work is accessible to other researchers, as well as the multicultural communities.

The study’s second recommendation is that health policy planners, researchers and clinicians include representatives of immigrant, refugee, ethnocultural and racialized groups in both planning and delivering mental health programs. This would help ensure that services are relevant and useful in meeting community needs.

Finally, the study recommends that organizations providing mental health services to these groups be culturally knowledgeable. Staff members, from the reception desk to the board room, must understand, respect and accommodate the needs of the groups they serve. They must also build a workforce that is rich in diversity.

What’s working?

The Improving Access to Clinical and Community Resources for Multicultural Mental Health Care project ( adopts these approaches. A project of the Multicultural Mental Health Resource Centre at McGill University in Montreal, it explores culturally sensitive ways for physicians to recognize and effectively treat mental health problems among multicultural groups.

Several provinces, including BC, Alberta and Newfoundland, provide health and other social services in many languages. In BC, for example, HealthLink (dial 8-1-1 or visit offers interpretation in over 130 languages to connect callers with nurses, pharmacists and dietitians. The toll-free provincial Mental Health Information Line (310-6789) and the Health and Seniors Information Line (1-800-465-4911) also have access to interpretation services.

In the United States, the Office for Minority Health has a website ( that not only contains information about both mental and physical illness for consumers, but has a section on “cultural competency” to help physicians become better at working with multicultural communities. There is also a section with demographic and health profiles for a number of these communities.

To read the Mental Health Commission of Canada’s report, visit

About the author
Judith  has taught art history at Simon Fraser University and Emily Carr University of Art+Design and has worked as a reporter and freelance writer. She now volunteers for a number of organizations, including the Canadian Mental Health Association, BC Division
  1. Hansson, E., Tuck, A., Lurie, S. & McKenzie, K., for the Task Group of the Services Systems Advisory Committee, Mental Health Commission of Canada. (2010). Improving mental health services for immigrant, refugee, ethno-cultural and racialized groups: Issues and options for service improvement [report].

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