Journey to Promote Mental Health: A Workshop for Community Workers

Serving Ethno-racial Communities

Hong Fook Mental Health Association

Raymond Chung, Linda Yoo & Maria LoApril 23, 2009

Goals

To heighten Participants’ awareness of the interconnectedness between Mental Health and Settlement Services

To enhance Participants’ knowledge base on Wellness, Mental Health and Mental Illness

OutlineOutline• Welcome & Introduction

• Holistic Health & Migration

• Cultural Competence

• Stigma & Mental Health

Break Time

• Introduction on Mental Health & Mental illness

• Introduction of Mental Health System

• Introduction to Community Resources

What makes someone healthy?

Most people think that our health is dependent on…

Some even think of “lifestyle”…

SocialInclusion

Income Education

Employment

Healthy Child Development

HousingFood

Health/Social Services

Safe PhysicalEnvironmentTransportation

.

Social Determinants of Health

Factors Affecting our Mental Health and that are

Particularly Important to Immigrants

Income and social status Social support networks Education and literacy, i.e. health literacy Employment / Working conditions Social environments Physical environmentsHealthy child development

Source: The Public Health Agency of Canada

Spirit

Mind Body

Capacity

Resources

Support

Roles &

ResponsibilitiesRelatio

nship

CommunicationAccess

Equity

Social JusticeResources

Supp

ort

UNDERSTANDINGMUTUAL

UNDERSTANDING

What needs to be addressed in promoting mental health beyond the

individual factors?

Biological/Genetic

Lifestyles Health Disparities

Individual

SocietalInequity In our social and health care system

e.g. public policies that lead to inequitable distribution of resources & power; systemic oppressions & barriers.

Health Disparities Result From…

Identifying the Stressors Associated With the Migration Process

Case Example:

Can you name stressors immigrants and refugees

may face?

Case Example- Ling is a 20 yrs old new immigrant who came from China

2 years ago with her mother- Ling is unemployed and attending ESL class - she appears to be passive, submissive, withdrawn and

seems to lack self confidence- Her mother was diagnosed with Depression in China

some time ago but has not reconnected with any mental health services in Toronto

- Ling is not sleeping well, waking up early, and talking about the lack of meaning in life after coming to Toronto

- Her father has been here for 15 years and works long hours as a chef to support the family

- The family shares a house with 2 other families with young children

Question:

If you are the settlement worker serving Ling, what are the stressors in her circumstances that you would attend to in supporting her?

Identifying the Stressors Associated With the Migration Process

Chronic Stress has been linked to the 6 leading causes of death:

Heart diseases CancerLung ailments

75-90% of all visits to healthcare professionals are for stress-related disorders

(Source: The Stress Solution by Lyle H. Miller, Ph.D., and Alma Dell Smith, PhD)

Cirrhosis of the liver

AccidentsSuicide

Moving Beyond Information Services

What could we do?as a frontline settlement worker……..

as an organization for your communities…….

to make system changes………

to reduce health and social inequities?

Mental Health & Mental Illnesses: A Cultural Competence Framework

Cultural Competence

Diversity

Gen

der

Age

Sexuality

CitizenshipStatusSocioeconom

ic

StatusC

lass

EthnicityMental/Physical

Abilities

Faith/Religion

Language

Other, etc.

Racial

Identity

The Diversity Flower has been adopted from the Power Flower (Source: Arnold, R., Burke, B., James, C. & Martin, D. (1991) Educating for a Change, Toronto, ON: Between The Lines)

SexismRacism

Ableism

Classism

Heterosexism/Homophobia

Other Oppressions

Ageism Inequities

.

While we may acknowledge diversity, we must also acknowledge that inequities and oppressions exist…

Overlapping oppressions impact negatively on the well-being of the individual, group or community

Each individual, group or community usually belongs to a set of overlapping dimensions

Definition of Cultural Competence

“ A set of congruent behaviours, attitudes and policies that come together in a system, agency or among professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations “

(Cross et al, 1989).

Am I culturally competent if I …

tell my Chinese client that I am Chinese too and an immigrant also, so I know what she is going through & needs to do. refer my client who is Vietnamese by ethnic origin to a Vietnamese-speaking counselor with the belief that this arrangement is culturally appropriate for her.share my client’s situation with his mother who did not tell her son that she was calling me with the assumption that family plays an important part in an individual’s life in Asian culture so parents should know what’s happening to their children.

Key Points

Holistic Health

Social Justice

Equity

Diversity

Stereotyping & labeling as

“Absolute No”

Interpretation of culture by the

individual

Critical Self Awareness &

Reflective Practice

Culture beyond language

compatibility

Cultural Competence at Service Level

Cultural Competence at Organizational Level

Cultural Competence at System Level

Warm up activities!!!!

How do we see mental health & mental illness?Statement #1: People with mental illness are violent and dangerous

Statement #2: People with mental illness are poor and/or less intelligent

Statement #3: Mental Illness is caused by personal weakness

Statement #4:If I do not have mental illness, it means I am having good

mental health

TRUE or FALSE

Stigma & Mental Illness

Stigma relates to:Misconception of mental illnessLack of knowledgeDiscomfort with differencesFear

Stigma & discrimination impacts on help seeking behavior & delay in treatment

15 minutes Break

What is Mental Health?

Mental health is about striking a balance in the physical, mental, spiritual, social and economic aspects of our lives.

Reaching a balance is a unique experience for each individual.

Mental Health as a Continuum

Mental Health as a Continuum

Wellness Illness

The 4 Ps of Mental Health

• Precipitating factors: triggered by stressful events.

• Predisposing factors: things that make a person more vulnerable to being distressed.

• Perpetuating factors: things that prolong the problem. The person’s road to recovery may be affected

• Protective factors: things that help recovery.

Some Early signs and symptoms of mental health issues (not a check list or an exhaustive list)

• Physical fatigue and low energy• Restlessness• Insomnia• Panic attacks• Loss of appetite• Weight gain or loss• Physical symptoms, such as headaches and

stomach aches

Other Common Symptoms• Increased irritability & anxiety• Racing thoughts• Poor concentration• Anger• Feelings of sadness• Crying easily• Changes in relationships with family members or

peers, • Loss of interest or motivation in studies or work• Absenteeism from school or work

WHAT IS MENTAL ILLNESS?

Mental illness is a medical condition that affects an individual’s thinking, mood and behaviour.

Mental illness is an illness similar to physical illness, but it is “invisible"

Mental illness is treatable and recovery is possible.

Different Types of Mental Illnesses

Psychotic DisordersExamples: Schizophrenia, Delusional DisorderMood DisordersExamples: Depression, Bipolar Affective DisorderAnxiety DisordersExample: Post Traumatic Stress DisorderOthers

How common are Mental Illness & Addiction Issues in Canada?

• 1 in 10 (aged 15 and over) – 2.7 million have symptoms consistent with a mood or anxiety disorder / alcohol or illicit drug dependence

• 1 in 20 met the criteria for a mood disorder, either major depression or bipolar 1 disorder

• 1 in 20 met the criteria for an anxiety disorder• 1 in 50 met the criteria for moderate risk or problem

gambling• 1 in 30 met the criteria for substance dependence

associated with either alcohol or illicit drug use

(The Human Face of Mental Health and Mental Illness in Canada 2006)

Other Statistics & Facts(Source: Mood Disorder Society of Canada)

Chances of having a mental illness in your lifetime in Canada: One in fivePercentage of people with chronic depression who die from suicide: 15%Annual losses to the Canadian economy due to mental illness & substance abuse in the workplace: $33 billionPercentage of Canadian workers who experience a stress related illness per year: 20%Number of people with mental illness either turned down for a job for which they were qualified, or if employed, dismissed or forced to resign once it was known that they had mental illness 1/3 to 1/2

So What do we do with this knowledge?

MENTAL ILLNESS IS TREATABLE

RECOVERY IS POSSIBLE!

Case Scenario• JJ is a 18-year old high school student• Immigrated to Canada 3 years ago, living with parents in

their 50’s. • Used to like studying and get along with parents until 7

months ago• Became withdrawn, lied in bed all day, not speaking to

parents, skipping classes• Ignoring personal hygiene, talking to self in his room,

said news reporter on TV is referring to him when watching news

• Parents upset about his changes and thought he could overcome his problem by pushing him to think and act differently

Any symptoms that we detect in JJ that are of concerns?

Treatment ApproachesPsychiatric Medication

ECTACTT

PsychotherapyAlternative Treatment

Psychosocial SupportGroup

Day ProgramVocational program

Peer SupportCase Management

Other Community Support

What can we do in dealing with mental health challenges?

Early Identification Understand associated factors and taking early steps to changeAssessment & Early TreatmentExplore Strategies in promoting mental health & coping with stressOrganizational & Systemic Changes beyond the individual level

Case Scenario: How do we provide support?• TK is a 35-year old female• Immigrated to Toronto 2 years ago from Mainland China• No English; university education• Living with 40-year old husband and 12-year old son• Couple were computer professionals in China• No job here and living on saving• Living on saving & tight finances• Poor marital relationship• Brother in Toronto & is supportive• Problems with Son’s behavior: seen as “rebellious”• TK is experiencing crying spells, loss of weight, poor sleep, social

withdrawal• TK is questioning the meaning of life and expressed thoughts of not

wanting to live

Case Scenario: How do we provide support?

What is our assessment of his needs & areas to work on?

How do we intervene?

How do we provide support?Questions to ask:AssessmentEarly Identification: What are the signs of mental health issues?- crying spells- loss of weight- poor sleep- social withdrawal- questioning meaning of life: Depressive thoughts, suicidal risk?

What are the associated factors & social determinants?- employment & financial stress- Unemployment & impact on self worth & self confidence- Marital problem- Problems in relationship with son & parenting possibly

How do we provide support?Intervention: How do we approach TK?

Critical self awareness & reflectionAssumptions, biases, roles & boundaries“Listening” v.s. “Advising”What are the “pressing” needs/issues to be addressed?Should we address suicidal risks by “exploring openly”?“Working alone” or “Working in collaboration”- with whom?What goals are achievable & immediate?What are the positives?Working “with” v.s. working “for” the individual

Mental Health System Mental Health System

Key Legislations Related to Mental HealthKey Legislations Related to Mental Health

Balancing

Rights & Choices to TreatmentSafety of Self & Others

Confidentiality

Mental Health Legislations

Key Legislations Related to Mental HealthKey Legislations Related to Mental Health

Mental Health ActMental Health Act””

““Involuntary AdmissionInvoluntary Admission””

““Health Care Consent ActHealth Care Consent Act””

Personal Health InformationPersonal Health Information Protection Protection Act (PHIPA)Act (PHIPA)

Introduction to the Mental Health SystemIntroduction to the Mental Health SystemContinuum of Mental Health Related Services Continuum of Mental Health Related Services --

Different Levels Different Levels of Treatment Services & Community Resources:of Treatment Services & Community Resources:

• Specialized Hospitals (Psychiatric Hospitals)• General Hospitals with psychiatric inpatient unit• Community Treatment Program (e.g. Assertive

Community Treatment Team, Outpatient clinics)• Community Support Programs, e.g. case management,

vocational support, supportive housing• Alternative Treatment Programs• Other community or social service programs,

(e.g., settlement service, employment programs, educational / vocational programs)

Linkage to Mental Health & Addiction Resources

CONNEXwww.connexontario.ca

Local CCAC211

Local CMHA

Only two ethno cultural specific community mental health organizations in the Toronto Region:

Across BoundariesHong Fook Mental Health Association

www.hongfook.ca

Mental Health & Addiction Resources

Crisis ServiceGerstein Centre 416-929-5200

Scarborough Hospital Regional Mobile Crisis Program 416-289-2434

St. Elizabeth Health Care Integrated

Community Mental Health Crisis Response Program 416-498-0043

Hong FookHong Fook’’s Continuum of Services s Continuum of Services FrameworkFramework

Get involved in the Health Care System!

Cross-sector collaboration with others in our work

Get informed and take part in giving your voice

Learning and getting involved in LHIN (Local Health Integration Network

(Reference: www.lhins.on.ca)

Educate & Advocate for individuals we serve regarding their rights

JOURNEY TO PROMOTE MENTAL HEALTH

An OCASI Staff Development Project 2008 - 2010

JOURNEY TO PROMOTE MENTAL HEALTH

A partnership project with OCASI, funded by CICAn 18 month project providing cross sector knowledge exchange2 day training series for front line settlement sector staff Goal is to raise awareness of mental health and to lower the stigma on mental illnessDesign of training series is geared towards the learning needs of the participantsAn Advisory Committee to provide guidance to the Project

Reflection for the Day…Feedback and Questions

Thank you & Have a nice day!

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