The Canadian healthcare system may be unfamiliar to black newcomers, but they receive a clear message of assimilation when accessing services, according to two leading black academics and mental health practitioners in Alberta.
“It’s almost like ‘turn inside out. Wash away everything you brought with you – be it belief systems, values, practices – then go back. [yourself] come back and then put new things on,” says Regine Uwibereyeho King, associate professor in the University of Calgary’s Faculty of Social Work.
Originally from Rwanda, King says the model of mental health applied in Canada is a deficit model, focused on figuring out what’s wrong with black migrants instead of looking at their resilience and how they are coping. their new environment.
Outdated Eurocentric framework
How the system is structured also has a big impact on people’s experiences, adds Sophie Yohani, a professor in the Department of Educational Psychology at the University of Alberta and originally from Tanzania.
Things like referring to a counselor, making appointments, the limited time given to clients, and the models used to address mental health issues are all based on a Eurocentric framework, she says. In this context, the ways of knowing people of African descent are not recognized.
In 2019-20, Yohani and King led research on actions that could be taken to promote mental health equity for Black Canadians. They used the “mind mapping” methodology to engage service providers, community leaders and volunteers who worked with Black Canadians in Edmonton and Calgary to generate and organize ideas.
They found that although participants identified having culturally relevant mental health services as one of the most important considerations, these services were seen the least in implementation, King said, and did not. were only at the community level.
“It is very ironic that many members of our black community have to rely on members of their own ethnic community or on black community associations that are created almost parallel to traditional services financed by … our taxes,” she says. .
“Then you see the gap – this notion that you can never be Canadian enough to deserve services that meet your needs.”
Amos Kambere is the president of Umoja Compassion Society of British Columbiawhich states their mission to help immigrants and refugees “integrate successfully into an inclusive Canadian society” and thereby “transition from newcomers to neighbours”.
Originally from Uganda, Kambere lived as a refugee in the Congo for four years before coming to Canada as a government-assisted refugee in 1992. Now he helps other refugees from war-torn areas in Africa, among others, through Umoja.
Rely on goodwill
Kambere says a lack of funding for community organizations like Umoja is reducing their ability to adequately help refugees struggling with mental health issues, leaving many “falling through the cracks”.
“If we had a community counselor stationed in our office, he or she would see a lot of these refugees,” says Kambere, “and use the cultural method, use the traditional method that refugees come with and support these refugees. before referring them to external agencies.
Instead, he says, Umoja relies on the goodwill of trained African professionals who take the time to help on a voluntary basis, which means mental health support is inconsistent and unsustainable.
The idea for Umoja grew out of Kambere’s own traumatic experience six months after arriving in Canada. Minutes after her three-year-old son answered a phone call from the dentist, social services arrived at her doorstep. The immediate assumption had been that the child was alone, he said, and they were surprised to find Kambere there too.
Ten years later, Kambere received a letter from the Ministry of Children and Family Development informing him that his file had been closed. He says realizing he had been watched for all those years was “more traumatic than the moment they showed up at my doorstep”.
Kambere thought of the many refugees arriving from camps who were uneducated and the similar challenges they might face and decided to start an initiative to help them navigate the different systems in Canada.
“Occasionally [people here] think [refugees] just come here for a good life. And even … [they’ve] were saved from a situation that their governments created,” he says.
“It might be a better life, yes, but it’s not their choice.”
According to Kambere, this misperception of refugees creates a barrier to healing, perpetuating their trauma, which creates a burden on the Canadian healthcare system.
Marie Jolie Rwigema, a postdoctoral associate at the University of Calgary’s faculty of social work, says the lens of racial trauma is missing in mental health services.
“People’s reasonable responses to racism are understood as psychological pathologies, on the one hand,” she says. “On the other hand, people’s traumas are not recognized because racism is so normalized. So, [it’s] both as overdiagnosis and underdiagnosis.
She gives the example of a young black man who may be referred to a community service provider for anger management advice, but the approach does not include exploring the reasons for his anger.
“The trauma is not just about your coping mechanisms, but the fact that you are in an ongoing context of violence that is directed at you because (of being) Black,” Rwigema explains. “So it’s collective. It’s individual. It is cumulative. »
Yohani says recent research shows that post-migration trauma impacts refugees more than pre-migration trauma because “it’s actually not safe in the new environment”, especially for people facing the systemic anti-black racism.
According to her, this underscores the fact that mental health must go beyond the treatment of clinical symptoms and consider all social determinants of health, including housing, employment and access to justice.
One of the recommendations from participants in the mind mapping study was for mental health service providers to work with communities to help them identify issues of concern and share their own knowledge, which could then be incorporated into services.
Traditional service providers need to hire more practitioners from countries where refugees come from, says Kambere, which would require dismantling systemic barriers for migrants with non-Canadian qualifications.
According to King and Yohani, more research and training is needed, requiring reliable funding that will allow them to build on the work done so far.
King says courses like an Afrocentric perspective on social work, which she is currently teaching with a colleague for the first time, also need to be incorporated into the university curriculum.
According to Yohani, there is also a need to create space for knowledge that has been silenced and marginalized.
This is increasingly relevant given Canada’s changing demographics, she says.
“A Eurocentric worldview no longer truly reflects the Canadian population and (of) whom the social workers, psychologists, psychiatrists…will serve.
ALBERTABlack RefugeesBritish ColumbiaCalgaryEdmontonMental Health Refugees