Anna Durbin: How immigrants are using mental health services

In brief

Canada has a limited amount of current research on how immigrants are using mental health services. With the second largest proportion of foreign-born individuals worldwide, we need to know more about the mental health service needs of immigrant groups. Most Canadian research to date has relied on health surveys to better understand immigrants’ mental health.

Research that used these data sources typically compared “immigrant” or “non immigrant”, and “immigrant less than 10 years” versus “immigrant less than 10 years”, according to student researcher Anna Durbin. This means that “we’re putting 30% of the population in one or two categories, even though immigrants from different regions and in different visa classes are extremely different,” she noted.

So she’s going to use administrative health services data linked to a Citizenship and Immigration Canada database, which record the details about each person who is registered with a provincial health plan. By doing this, she’ll be able to examine how the entire immigrant population in Ontario, grouped by various characteristics, is using a variety of mental health services.

EENet has developed a Student Spotlight on Anna’s work. Student Spotlights are brief profiles of up-and-coming student researchers.

Read it below or download the PDF.

About Anna

Anna is a doctoral candidate in the health services research stream at the Institute of Health Policy, Management and Evaluation (iHPME), University of Toronto.

In spring 2010, she received a Doctoral Award from the Canadian Institute for Health Research to support the first three years of her doctoral degree, and an Ontario Graduate Scholarship for her fourth year.

She has contributed to projects that looked at how different physician reimbursement models affect delivery of mental health care.

Anna earned her Masters of Public Health in Community Health & Epidemiology at the University of Toronto’s Dalla Lana School of Public Health. She graduated with a Bachelor of Arts with Specialized Honours in Psychology from the Faculty of Health at York University.

Project Title: Mental health service use patterns for immigrant groups and long term residents in Ontario

Project Supervisors: Dr. Richard H. Glazier, Senior Scientist, Institute for Clinical Evaluative Sciences, Scientist, Centre for Research on Inner City Health St. Michael's Hospital, Professor, Family and Community Medicine, University of Toronto

What Is Anna’s research about?

For her project, Anna plans to look at how immigrants in Ontario use mental health services. Specifically, she wants to find out if use is different, depending on how long a person has been here, where they come from, their visa type, or the neighbourhood where they live.

Anna explained that one of the reasons she chose to focus on this issue is that there’s a limited amount of current research on how immigrants use mental health services in Canada.

With the second largest proportion of foreign-born individuals worldwide, Canada needs to know more about the mental health service needs of its immigrant groups, Anna said.

“There’s an international body of literature, particularly in parts of Europe, that looks at how various immigrant groups use mental health services,” she said.

“But in Canada, there is much less research.  Some studies have looked at length of time in Canada and how that relates to service use for non-psychotic disorders, like depression, she added. But in terms of more severe and typically more disabling disorders—schizophrenia in particular—there have been no individual-level studies in Ontario since the 1970s.

“Obviously, the landscape or mental health has changed [since that time]. The landscape of immigrants in Ontario has changed dramatically,” she explained. “And especially since immigrants compose roughly 30% of the Ontario population, it seems like we should know more about their mental health care needs and mental health use patterns.”

Also, most Canadian research to date has relied on health surveys to better understand immigrants’ mental health, she explained. Research that used these data sources typically compared “immigrant” or “non immigrant”, and “immigrant less than 10 years” versus “immigrant more than 10 years”, she said.

This gap in knowledge means that “we’re putting 30% of the population in one or two categories, even though immigrants from different regions and in different visa classes are extremely different,” she noted.

Surveys can provide a personal perspective but they also have some limitations:

  • They included only people who speak English, or a small number of other languages, rather than the whole population of foreign-born individuals;
  • They asked people to report about their mental health, so they may not have been accurate;
  • Most looked at responses at one specific time, rather than over a long period of time; and
  • They’re less complete and accurate than administrative data , which is collected primarily for administrative (not research) purposes.

Instead, Anna is going to use administrative health services data linked to a Citizenship and Immigration Canada database.  

Administrative databases record the details about each person who is registered with a provincial health plan. They include details about inpatient and outpatient hospitalizations, visits with physicians or independent health professionals, filled prescriptions, home care visits, and nursing home stays.

“One of the key things that appeals to me, that really excites me about this research, is that I’m going to be disaggregating [the information] based on region of origin—there will be nine regions of origin—time in country, or time since immigration, and visa class. And then, I’ll hopefully look at some neighbourhood characteristics as well. If they’re living in an impoverished area, will it have the same effect on an immigrant as on a Canadian-born person?”

By linking immigration and health services databases, Anna will be able to examine the use of a variety of mental health services by the entire immigrant population in Ontario, grouped by various characteristics.

The main limitation of this data source is that there is no information on mental health need, only on service use. Some other desired information that could help to group immigrants is also not available, such as ethnicity.  Anna said she hopes to examine how this information affects mental health service use in future research.

Anna explained that the idea for her project arose from her own experience, having witnessed members of her family and friends experience some form of mental illness while also struggling to find their way through what she feels can seem like a complicated and fragmented mental health care system.

A thought came to her, she said: If someone who is fluent in English and knows their way around the health care system found it difficult to access all the services they needed, then how could someone who does not speak the language well, or understand how the system works, ever expect to get adequate care?

Her research, she hopes, will achieve several goals in the short term:

  • Draw attention to immigrant mental health service use patterns;
  • Facilitate a discussion about possible explanations and policy responses; and
  • Suggest areas for future research.

She intends to share her findings with Ontario decision makers, mental health service managers and providers, and other academic researchers.

What’s next for Anna?

She hopes to one day contribute to public policy that supports the mental health of vulnerable groups, including immigrants. She said that she sees a future for herself as a policy analyst, as an academic, or both. For more information about Anna’s study, please contact her at Anna [dot] Durbin [at] utoronto [dot] ca.

Author: Rossana Coriandoli