Reprinted from the "Culture" issue of Visions Journal, 2014, 9 (4), p. 33
From April 2010 to March 2012, the REACH Multicultural Family Centre, located in East Vancouver, was the lead agency for Creating a Sense of Belonging: Mental Health Promotion Within Immigrant and Refugee Communities. REACH partnered with immigrant-serving organizations, community centres and community health and mental health agencies to promote the mental health and well-being of specific high risk immigrant and refugee communities in Metro Vancouver. This two-year project was funded by the Community Action Initiative (CAI) (www.communityactioninitiative.ca), a provincially funded mental health promotion initiative to address substance use and improve the mental health of British Columbians.
A key feature of this project was the involvement of cross-cultural health promoters (CCHPs), also known as cross-cultural health brokers (CCHBs). (In this context, brokers interpret the culture of a client to the health care provider, and the culture of the health care system to the client, in the client’s language.) CCHP/Bs are members of a cultural community who have knowledge of the values and beliefs of their own culture, as well as knowledge of the values and beliefs of the dominant culture in Canada. CCHP/Bs can bridge the cultural and language gap between them.
The CCHP/Bs in this project were community leaders from particular immigrant/refugee communities—that is, people who are well-known and trusted by members of the community and who are familiar with the sociopolitical dynamics of that community. They had Canadian credentials in social work or counselling and/or they were foreign-trained health professionals.
Based on community input, the project developed two components: social support groups; and capacity-building activities.
Social support groups: CCHP/Bs from six diverse cultural groups worked within their communities to develop and implement culturally responsive social support groups. The social support of family and friends, including supportive relationships, involvement in group activities and social engagement, is solidly linked to mental health and well-being.1
South Asian Senior Women’s Community Kitchen: Rashmi Rajema, CCHB from the Umbrella Multicultural Health Co-op, facilitates a community kitchen for South Asian senior women in New Westminster. The women come together over cultural recipes to share their experiences with how family and social roles are changing, and to talk about stresses related to settlement, culture and gender. Cooking together creates an open, supportive and sharing environment. “[The program] has allowed me to make contact with other women, who are like my extended family, with whom I can share and learn new things.”
Afghan Women’s Social Circle: Another Umbrella Co-op: CCHB, Zarghoona Wakil, facilitates this group for Afghan women, with the aim of preventing isolation and helping them manage stress. The women meet in a community school located in a neighbourhood with a large population of Afghan refugees. They discuss topics and issues related to family and cultural conflict, such as parenting, religion and gender roles. Wakil conducted a survey to evaluate the group’s perspective on the program, and found that 75% of the participants felt a better sense of belonging in the community they live in. “I’m engaged in the events of Afghan community; I cannot engage in others because of language issues.”
Latin American Seniors’ Social Club: This self-help and peer support group meets weekly for socialization, recreation and cultural activities. Activities include day trips, workshops on a variety of topics, on-site healthy meal preparation and leadership training. The group is governed by its own elected executive committee, and is facilitated by Pedro Ramirez, a CCHP from the REACH Multicultural Family Centre. Pedro reports that participants surveyed said they experienced reduced social isolation and felt more connected with their cultural community since joining the group.
Latin American Tertulias: This support group is for professional men and technicians who have come from Latin American within the past five years. German Blanco, also a CCHP with REACH Multicultural Family Centre, coordinates the prevention-focused weekly gathering. Using the Latin American cultural tradition of the tertulia (a regular informal social gathering where issues of common interest are discussed), the group has learned about anxiety, stress, depression management and how to overcome the loss they experience in a new culture. A survey indicated that 89% of the participants felt better able to cope with daily problems since joining the group, and feel safe in this country.
Mujeres Latinas en Accion (MLA): This group provides a networking opportunity for Spanish-speaking immigrant and refugee women in a friendly and informal setting. Stella Castillo, the group facilitator, uses meditation and neuro-linguistic programming (NLP) methods to foster self-esteem, positive thinking and high morale. NLP is a model of interpersonal communication that teaches participants self-awareness and effective communication, and helps them to change their patterns of mental and emotional behaviour. “During an MLA meeting, I talked about how we faced many situations that made us a little depressed... I decided to come to this group to change the air I breathe.”
Vietnamese Seniors’ Health and Wellness Program: This group provides an opportunity to socialize, as well as a physical activity program (e.g., line dancing and ballroom dancing) that promotes a healthy and active lifestyle. Thoa Lam, another REACH Multicultural Family Centre CCHP, has also introduced a self-care component to the program, which includes healthy eating and stress management. Group participants report having increased energy to take care of themselves and their family. Group members have also expanded their participation in community activities such as yoga and relaxation, stress management, community outings and craft projects. “I used to be at home alone, but now I have met new people in the group, so I feel better, not like an old person.”
African and Middle Eastern Women’s English Support Group: REACH Multicultural Family Centre CCHPs Grace Wattanga and Inas Lasheen facilitate a social support group for women from a variety of African and Middle Eastern countries. Social support is provided through an adult literacy class that focuses on practising English. Improving the women’s English increases their self-confidence and enables them to participate more fully in the community, increasing their sense of belonging. “Coming to the group is like taking care of myself, and after coming to the group I feel I can take care of my family better because I feel stronger.”
Helping communities promote mental health
The second component of the project involved activities to build the capacity of immigrant and refugee communities to promote mental health.
First, CCHP/Bs were trained, through a partnership with the Vancouver Coastal Health Cross-Cultural Mental Health Program, to better assist their community members who are experiencing depression, anxiety, major life stressors or transitions related to immigration and acculturation. They participated in a culturally adapted version of Changeways, a psychoeducational group therapy program that introduces clients to basic mental health self-care. The CCHP/Bs were able to use these principles in their group programs to assist and empower community members in managing their stress and cope with their depression and anxiety.
Then, CCHP/Bs and key community leaders took Mental Health First Aid (MHFA) training. MHFA is a world-wide program originally developed in Australia, which is available in Canada through the Mental Health Commission of Canada. MHFA training helps service providers to enhance the understanding of mental health issues in the Western context within immigrant and refugee communities, providing skills to identify and assist community members experiencing mental health problems, and for some, lessening the stigma associated with mental illness.
Many cultural communities have different understandings of mental illness. Having an awareness of the Western concepts helps the CCHPs and other community members to bridge the cultural gap when assisting members of their communities to access services and treatment. For example, the son of a woman who had taken the training was recently diagnosed with a major mental illness. She was able to understand that his behaviours were part of his illness and to support him in getting treatment.
Ideally, the training participants will spread knowledge and expertise on a larger scale among their related cultural communities and settings. This will increase the understanding of, and familiarity with, mental health issues throughout the wider community.
In the two years since the project ended, the Multicultural Family Centre has been successful in maintaining most of the social support groups with new funding from other sources. The concept of mental health promotion has taken hold in the centre, and has become, along with our Healthy Eating Active Living strategy, one of our “guiding principles” in program planning.
The increased level of awareness and understanding of the concept of mental illness among staff and volunteers from a variety of cultures has opened up a more respectful dialogue about mental illness. This is decreasing the stigma and creating a healthier environment for program participants affected by mental illness.
About the author
Germán, a Family Doctor who practised for 22 years in Colombia, currently works with the REACH Community Health Centre as a Cross-Cultural Health Promoter, focusing on chronic disease prevention and mental health promotion. A trained diabetes educator, he facilitates diabetes prevention and management groups and a support group for immigrant and refugee professionals
Patricia is manager of the Multicultural Family Centre at REACH and works with immigrant and refugee communities to develop culturally responsive health promotion programs and services. With a professional background in mental health, Patricia is committed to addressing the impact of the migration process on the health and well-being of immigrants and refugees
Pedro is a Cross-Cultural Health Promoter at REACH Community Health Centre, assisting members of the Latin American community to access health and other community services. He facilitates culturally responsive programs and services for the Latin American community, including peer support groups, drop-in counselling and practical-assistance sessions
- Simich, L., Beiser, M. & Mawani, F.N. (2003). Social support and the significance of shared experience in refugee migration and resettlement. Western Journal of Nursing Research, 25(7), 872-891.