Seeds of Change engages and educates service providers about mental health & addiction needs of refugees and immigrants

In brief

Immigrants and refugees often face challenges adjusting to life in Canada. Sometimes, the challenges are poverty, language barriers, or difficulty finding adequate employment. Other times, it’s a lack of social support caused by distance from family and friends. It can also involve past trauma or settlement-related discrimination and exclusion. These difficulties can cause significant personal and family distress. 

The Seeds of Change project in London, Ontario, was created as a community response to engage and educate service providers about the mental health and addiction needs of refugees and immigrants, who make up about 22% of the city’s population. This community-led initiative started as a collaboration by the Networking for an Inclusive Community, London & Middlesex Local Immigration Partnership, and the Political War Trauma Work Group. The Centre for Addiction and Mental Health also supported the project since its inception.

In this issue of Promising Practices, EENet's Michael Weyman provides an overview of the Seeds of Change project. Read about Seeds of Change below or access the PDF.

“There is such a need for mental health supports for refugees who have fled war torn countries. People are scared or ashamed to talk about their mental health problems… We need to know how to provide and find support for them.” 
–Settlement worker 

Background

Immigrants and refugees often face challenges adjusting to life in Canada. Sometimes, the challenges are poverty, language barriers, or difficulty finding adequate employment. Other times, it’s a lack of social support caused by distance from family and friends. It can also involve past trauma or settlement-related discrimination and exclusion. These difficulties can cause significant personal and family distress. 

People, seated in groups at tables, in a conference room, talking with each other
Participants having a discussion at Seeds of Change community forum in London, ON.

Research shows that refugees and immigrants generally access mental health and addiction services less often than people born in Canada and face numerous barriers to accessing these health care services.1,2,3 Some of these barriers include:

  • a lack of knowledge about the services that are available;
  • not understanding how to access services;
  • a mistrust about these services;
  • language barriers; and
  • economic constraints.3

The Seeds of Change project in London, Ontario, was created as a community response to engage and educate service providers about the mental health and addiction needs of refugees and immigrants, who make up about 22% of the city’s population.4 This community-led initiative started as a collaboration by the Networking for an Inclusive Community, London & Middlesex Local Immigration Partnership, and the Political War Trauma Work Group. The Centre for Addiction and Mental Health also supported the project since its inception. The objectives are to: 

  • reduce stigma and discrimination by facilitating dialogues between service providers, and immigrants and refugees about addiction and mental health issues; 
  • increase the knowledge and awareness of service providers regarding the impact of immigrant and refugee cultural beliefs and norms as well as post-migration experience;
  • foster supportive environments in immigrant and refugee communities by increasing understanding of addiction and mental health issues; 
  • increase knowledge among immigrant and refugee communities about mental health and addiction issues in the context of pre-migration trauma and other experiences; and
  • create supportive services for immigrants and refugees with mental health and addiction concerns. 

The approach

Seeds of Change is committed to community integration and engagement in all its activities. The initiative began in 2011 by consulting leaders in faith, settlement, and educational organizations that have frequent interaction with immigrants and refugees in London. The goal was to identify key community partners, learn how to form effective partnerships, and discuss mental health and addiction issues within ethnocultural groups in the city. The engagement helped build connections with community members and organizations and identify local needs and service gaps. 

Participants seated in groups at tables, talking with each other
Participants sharing views at Seeds of Change community forum.

An initial community forum began with a theatre production for an audience of more than 100 members of the community, which showcased the struggle of immigrants to navigate the complexities of the Canadian mental health care system. This performance aimed to increase service providers’ awareness of the issue and newcomers’ understanding of Canadian mental health and addiction supports. It also created common ground for constructive conversations about mental health and addiction service needs in London. 

The project used conversation circles to promote discussions among immigrants, refugees, and service providers on several themes, including:

  • communication,
  • stigma,
  • engagement, 
  • mentorship, 
  • trauma, and 
  • support needs. 

Between 2012 and 2013, there were 15 conversation circles with 102 participants. In part, the project learned that London needed culturally-sensitive print and electronic resources on addiction and mental health and that refugees and immigrants wanted more opportunities for supportive group interactions among themselves and service providers.

As a result of the conversations, Seeds of Change developed a series of pamphlets in four languages that include:

  • key definitions of mental illnesses, addictions, suicide, and stigma; 
  • signs and symptoms of mental health and addiction concerns; 
  • strategies for self-help; and 
  • community services in London that provide help and further information. 

man and woman laughing, holding up their certificates
Completing a Seeds of Change train-the-trainer workshop in London, ON.

In addition, the project created a comprehensive mental health and addiction toolkit in response to an identified knowledge gap among faith leaders, settlement workers, and English-as-a-second-language (ESL) teachers. This toolkit was designed to increase their ability to recognize and respond to the mental health and addiction needs of refugees and immigrants.

The toolkit describes common mental health and addiction issues and possible warning signs and explains ways to engage in culturally-sensitive conversations. Furthermore, it includes descriptions of the types of supports available in the London area and of situations when emergency services should be contacted. 

Seeds of Change subsequently developed a train-the-trainer workshop on cultural competence, local mental health and addiction supports, and how to use the toolkit for community organizations in the London area. 

To broaden the reach of the training, attendees signed a written agreement that, within six months of completing the workshop, they would offer the workshop themselves at least once. The initiative held five workshops and successfully trained 151 service providers. 

“The Seeds of Change project provides service provider organizations with re-enforcing tools on how to be culturally competent to create a positive welcoming space for immigrants who experienced pre- and/or post-migration vicarious trauma.” 
–Settlement service manager 

What worked

The project successfully targeted its work to different groups, namely (a) immigrants and refugees, (b) educators, faith leaders, and settlement workers, and (c) mental health and addiction workers. Commitment to grassroots engagement helped build effective relationships within these target groups. Since June 2011, Seeds of Change engaged approximately 327 people, representing over 30 service agencies and 32 cultural groups.

This engagement strategy gave rise to the multifaceted design of this initiative, which included mentorship, training, and resource development. It also shaped the products that Seeds of Change developed. For instance, the content and design of the pamphlets and toolkit emerged from discussions in the conversation circles. The resources were then brought back to the community for review and feedback. This process ensured that the pamphlets and toolkit were meaningful, comprehensive and useful for diverse community groups.

Group of people standing together
Instructors and participants at a Seeds of Change train-the-trainer workshop.

Seeds of Change also responded when they heard that immigrants and refugees were looking for more opportunities:

  • to practice English, 
  • to connect with service providers,
  • to gain employment aligned with their credentials, and 
  • to integrate with Canadian society. 

In response, it established its mentorship program and held community forums to encourage dialogue among refugees, immigrants and service providers. In addition, the project hired several immigrants and refugees to provide outreach, deliver training, and share the resources in the community. These individuals identified that this employment opportunity improved their self-esteem, fostered a sense of belonging, and built their local work experience, which helped with future job-finding efforts.

Lessons learned

The individual stories and experiences shared during conversation circles and community forums built awareness and empathy. They also provided direction in the design of the project and the development of its educational resources and training modules.

Through community engagement, Seeds of Change found that ESL teachers, settlement workers, and faith leaders lacked knowledge about mental health and addictions and about related community services. Increasing their capacity to recognize, intervene and support the psychological well-being of refugees and immigrants was instrumental to the overall success of this project.

The initiative overcame several obstacles, including funding interruptions and turnover among staff, steering committee members, and umbrella organization leadership. The longevity of Seeds of Change reflects the passion, commitment, and perseverance of its members to improving mental health and addiction supports for refugees and immigrants in the community. Seeds of Change project members also learned the importance of allocating resources to coach service providers on the use of the toolkit and to evaluate its impact. 

The project is currently seeking additional funding to support continued implementation and evaluation in London, as well as to expand into other communities.

This approach shows significant potential to better support refugees and immigrants in London and across Ontario and could be adapted to meet the needs of other communities. The educational resources were designed to be portable and adaptable for use by a variety of organizations working with refugees and immigrants. 

EENet Perspective

The Seeds of Change initiative aligns with the Government of Ontario’s commitment to ensure health equity within the mental health and addiction system. Gaps in culturally sensitive and equitable mental health and addiction care still exist in the province. 

Through extensive engagement, this regional program has not only identified health equity challenges facing immigrants and refugees in London, but has collaboratively developed a multi-faceted approach to address these problems. This is a promising practice that other groups can use to support the diverse mental health and addiction needs of refugees and immigrants. 

For more information:

  • Seeds of Change pamphlets for refugees and immigrants
  • Seeds of Change resources for faith leaders and professionals

For more information on the project and its train-the-trainer sessions, contact Janet McAllister at Janet [dot] McAllister [at] camh [dot] ca

Author:
Michael Weyman &
Christine Kluczynski 
July 17, 2017

References

  1. Durbin, A., Moineddin, R., Lin, E., Steele, L. S., & Glazier, R. H. (2015). Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study. BMC Health Services Research, 15(1). https://doi.org/10.1186/s12913-015-0995-9
  2. Guruge, S., & Butt, H. (2015). A scoping review of mental health issues and concerns among immigrant and refugee youth in Canada: Looking back, moving forward. Can J Public Health, 106(2). https://doi.org/10.17269/cjph.106.4588
  3. Stol, J., Khanlou, N., Nguyen, H., Tran, V., Omer, S., Yip, A., … Carter, Charlie. (2015). Taking action on health equity and diversity: Responding to the mental health needs of children, youth and families new to Canada. Ottawa, ON: Ontario Centre of Excellence for Child and Youth Mental Health. Retrieved from http://www.excellenceforchildandyouth.ca/sites/default/files/policy_newc...
  4. Statistics Canada. (2013, May 8). London (City), Focus on Geography Series, 2011 National Household Survey (NHS). Retrieved March 24, 2017, from http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/fogs-spg/Pages/FOG.cfm?lan...