Transcript Slide 1

Newcomers’ mental health
Kwame McKenzie MD
Think big!

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Fabulous initiative – thank you
 An
economically strong
Toronto and Canada
needs newcomers with
excellent mental health
 Promoting
mental
health and preventing
mental illness in
immigrant groups is a
vital investment for the
future of Canada
+ Outline of talk
Canadian research on mental
health in newcomer and diverse
populations
An idea to discuss on one way
we can improve matters
Canadian literature: mental
health of IRER groups
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Canadian research on mental
health of immigrants &
newcomers
 Rates
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Causes
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Service development and use
Rates: newcomers health
deteriorates over time (Newbold 2005)
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Rates: European migrants least likely
to have deterioration in health (Kim 2013)
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Causes of illness & pathways to care
(McKenzie 2004)
Causes: Social determinants (Hanson 2011)
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More detrimental social determinants
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Novel social determinants
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migration, discrimination and language difficulties.
Fewer social forces that decrease risk
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Causes: higher risk of problems with
income and housing (PHAC)
*
Causes: decreasing comparative
earnings of newcomers (PHAC)
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0.9
0.8
0.7
0.6
0.5
0.4
0.3
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0.2
0.1
0
1980
Males w Univ. Deg
1990
Females w Univ. Deg
2000
Males w/o Univ. Deg
2005
Females w/o Univ. Deg
12
Causes: type of housing and work
linked to psychological issues in
refugees
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Causes: risk of psychosis in ethnic
minorities linked to social capital (Boydell)
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Predicted incidence rate (per 100,000
person-years)
80
70
60
50
40
White
BME
30
20
10
0
Low
Medium
High
Social cohesion and trust (ward-level)
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14
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Causes and mechanisms: impact of
racism on health pascoe & richman
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Causes: newcomers affected by other
societal trends
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City1 City2 City3
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1/3 of people in City 3 live under
low income cut off
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50% of the housing for families
in City 3 is high rise
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More visible minorities in City 3
than City 1
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Proportion of whites in City 3 is
falling
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+Poverty is color coded
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Problems in services and
academic sector also
important
Barriers to care
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Less likely to get care and poorer care received
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Numerous barriers eg:
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Awareness and stigma
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Pathways unclear
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Models of care and personnel not acceptable
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Lack of cultural competence and sensitivity
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Financial barriers
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Language
Pathways to Care – African Group (n=25) (Anderson in press)
n=1
Police &
Criminal Justice
(n=6)
n=1
n=13
n=2
n=3
n=1
n=11
n=27
n=9
Emergency
Department
(n=6)
n=2
n=2
n=1
n=6
n=2
n=1
General
Practitioner
(n=11)
n=1
n=3
n=2
n=3
n=2
n=1
n=4
n=1
Other
(n=1)
n=1
Outpatient
Psychiatry
(n=1)
n=1
n=8
n=1
Early Intervention Services
n=2
Inpatient
Admission
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% immigrant population by electoral
ward
Things that work: facilitators of care
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Acculturation
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Knowledge and education
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Ethno-specific health promotion
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Trust in the system
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Cultural competency
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Co-operation between service providers
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Diversity of services including alternative approaches
Story of resilience under strain
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Increased social determinants causing problems
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Novel social determinants because of being
member of ethnic group
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Decreased social factors preventing problems
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Sector offers little focus on mental health
promotion and prevention
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Difficulties in getting the right care
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Sector does not offer systematic response to
needs
What do you do with a
problem so huge?
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Plan or plan to fail… what works
Data – accountability – plan - measure
Decide who is responsible for what and
what your place is…
Differential
rates
Inequitable
service
response
Context in which
need & service
response occur
Clinicians and
teams
X
Organisation
X
X
Service system XX
X
X
Societal /
legislative
X
X
XX
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Best treatments are linked to good
diagnosis
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Our diagnosis is that multiple levels of
actions are needed
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Caring immigration strategy and support
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Action on social determinants
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Specific support for newcomers and new
comer communities
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One stop shops
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Health promotion
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Better and more diverse service sector
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Better linkages of services based on
needs
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Specific evidence based services and
interventions
Would this idea help newcomers
in Toronto? If so… steal it!
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Most important policy priority for
improving mental health &
disparities
Prevention of mental illness
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Promotion of mental health
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What level should we work at
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Individual level
Group level
Societal level
What timescales
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Outcomes now or build for the future?
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Diagnosis helped by: the Government Office for Science.
Advice of 400 international experts.
The report takes a futures approach to strategic policy thinking.
Most important opportunities &
challenges for the UK in the next
20yrs
• Preserving the independence of the ageing population and
making their knowledge available to industry
• Nurturing the cognitive and emotional flexibility of the population
and equipping them to deal with changing work and society
• The increased expectations of the population
• A movement of public services towards more choice, active
citizenship and co-production
• The need to harness technology and science to promote
wellbeing
How can this be done
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Our mental resources are key to meeting the challenges,
individually and as a country
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These resources = mental capital
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(IQ, EQ and mental health)
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IQ = cognitive ability, flexibility and efficiency at learning,
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EQ = emotional intelligence, such as their social skills and
resilience in the face of stress.
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These are linked to mental health = how well an individual is
able to contribute effectively to society, and also to experience
a high personal quality of life.
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Improving mental capital
is the most important
thing.
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IQ = schools
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EQ = ?
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Mental health – social
policy and public health
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Evidence-based
approaches to promotion
of mental health.
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But often not cross
culturally validated or
shown to promote equity
Fundamental social causes – well meaning
initiatives can increase inequity (Link and
Phelan)
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Unless you target the reason for the inequity it is difficult to decrease
inequities
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Explains why the association between socio-economic status and health
disparities persisted over time, despite interventions, and even after
conditions previously thought to be the cause had been resolved.
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Higher SES is an indicator for an array of resources including money,
knowledge, power, and beneficial social connections.
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Ensure that disparities continue, unless interventions specifically target the
factors and mechanisms that sustain differences between population
groups.
Improving mental capital equitably
requires…
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Targeting the fundamental social causes of disparities – eg
power and linkages to power.
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But
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Modern strategies that work promote greater choice, active
citizenship and co-production to deliver public services.
Moving towards rights and power
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To promote mental capital,
decrease inequalities and
improve active citizenship
we need more than mental
health interventions and
services.
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We need an effective
strategy to increase the
access of the most
marginalised in society to
opportunities to influence
decision makers and
resource allocation.
Fundamental causes may need
fundamental change
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Rather than a single intervention, the way in which the health
sector runs its business may offer a way to meet all these
needs.
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Move from community engagement to community marriage.
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The introduction of participatory budgeting may help more
equitable decisions to be made, while increasing public
engagement in decision making.
What is participatory budgeting
Participatory budgeting
directly involves
communities in making
decisions about how to
spend public money.
A percentage of core
budgets go to community
led schemes
Citizens identify, discuss
and prioritise public
spending and have the
power to make decisions
on how the money is
spent.
+ How is it done
Community members identify priorities and identify
people from within their ranks to help work them up
They then sit with experts and planners to produce actual
proposals.
Community members vote on which proposals to fund
and the municipality implements the top proposals within
the money allocated
Participatory budgeting Being
used world wide – but not yet for
health
Advantages of participatory
budgeting
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health sector demonstrate their vision of a population having
shared responsibility for public health;
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engage the population in discussions of public health and offer
an avenue for identifying local priorities, and for consultation;
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develops vertical social capital locally and directly
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target fundamental causes of disparities such as power and
access;
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produce fairer, better-informed decisions about priorities which
improve the effectiveness of existing and well known mental
health interventions.
Participatory budgeting could unlock the
potential for newcomers and communities
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Harness expertise and knowledge of newcomers
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Increase community voice
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Demonstrate and develop self-efficacy
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Develop more competent policy arena
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Move power and resources from city 1 to city 3
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Increase access to power and jobs
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Focus community on health promotion
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Better illness prevention and services
 An
economically strong
Toronto and Canada
relies on us investing in
the mental capital of
newcomers
 Services
are important
but prevention is better
than cure
 We
need to right size
our thinking on
newcomer mental
health
+
Think big!
Newcomers are the future of Canada
Thank you