Challenges and advancements in providing
access to mental health services for diverse
patients in Canada
Lola Bendana
[email protected]
Prepared for:
Scottish Universities Insight Institute
Heriot-Watt University
University of Strathclyde
Psychiatry Unit, St John’s Hospital
Mental Welfare Commission for Scotland
April 9, 2015 - Glasgow
Immigration in Canada
o Why Professional Interpreting Services?
o Provision of Services
o Challenges
o Advances
o
Multi-Languages Corporation
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Immigration in Canada
New patterns of immigration poses new
challenges for the delivery of mental health
services.
For the first 100 years of Canada being formed
as a country, immigration came from Europe.
Multi-Languages Corporation
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Since the 1960’s there has been a shift in
immigration sources.
In Canada, the proportion of the population
that requires an interpreter for health care is at
least 1 in 50, and possibly much higher.
Over 100 languages are spoken in main cities
Toronto, Montreal, Vancouver
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Very diverse situation from province to
province. Issues are accentuated in smaller
communities.
Some communities are not well prepared for
diverse immigrants.
Since 1990 Canada has accepted approximately
230,000 immigrants per year, mostly from
countries where English is not the first
language.
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Ontario is the most ethnically diverse province
in Canada - its residents speak more than 200
languages and dialects.
Over one quarter of the population has a
mother tongue other than English or French
(Statistics Canada, 2007).
Immigrants make up 41% of the population in
the Toronto Central Local Health Integration
Network.
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Why Professional Interpreting Services?
Effective communication is crucial to
providing quality health care.
Qualified interpreters ensure that people who
are not fluent in English or French have fair
access to high-quality mental health services.
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Language barriers pose limitations to informed
consent, can delay needed services, lead to
unnecessary testing, lengthen hospital stays,
increase emergency room use, interfere with
follow-up care and waste scarce resources by
tying up health care providers' time. (TC
LHIN, 2010).
9
Interpreter services have particular importance
during mental health assessments and
counselling sessions.
Even when patients know basic English, their
command of it may not be adequate to allow
for mental health assessment or for detailed
information gathering, particularly when they
are in distress.
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Inadequate communication can have
significant clinical consequences, including
(Miletic et al, 2006):
o underestimation or overestimation of the
severity of mental health problems
o failure to correctly identify the type of mental
health problems present
o diagnosis of mental health problems that are
not present.
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Provision of Services:
Canadian Universal healthcare
o Equal access to mental health services to all
Mental Health Programs offered at:
o Family medicine clinics
o Hospital Psychiatric departments
o Community health centres, etc.
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Provision of Services:
Modalities
o Face to Face
o Video Interpreting
o Telephone Interpreting
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Challenges:
Lack of culturally and linguistically
appropriate mental health services further
contributes to stigmatization and
marginalization of ethno-racial/cultural
communities exposing them to additional
risks of developing mental health problems.
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Challenges:
o
Mistrust was identified by some studies as a
major barrier to receipt of mental health
services by racial and ethnic minorities
o
Vast spectrum of beliefs about mental health
model and treatment
o
i.e. susto
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Challenges:
o
Culture divide –stigma
o
cultural barrier as important as linguistic barrier
o
People hesitant to ask for help
o
Lack of recognition of language as basic
human right
16
Challenges:
o
Lack of standard policy or processes
o
o
o
o
Wide difference in provision of services through the
country, hospitals that fully engaged only professional
interpreters to those that still use the services of adhoc interpreters and family members
Different training in different provinces
Smaller communities can’t fully abide by national
standards
Video/Telephone interpreting
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Challenges:
o
Funding
o
Lack of knowledge of the health system and
how it functions
o
Lack of understanding from families
(partners in the care and treatment)
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Challenges:
o
New immigrants/refugees
o
o
o
o
o
o
o
adaptation issues
job changes
family dynamics change - younger members adapt
better
Finances
Discrimination
PTSD in case of refugees
fear of psychiatry
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Barriers identified by immigrants include:
o
o
o
o
o
o
o
fear of speaking English
suspicion of authority
isolation and sense of being an outsider
reliance on children to find accurate information
lack of familiarity with Canadian information
sources
cultural differences
absence of knowledge of how to ask for services
Multi-Languages Corporation
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Sample challenges
Cognitive examinations
In the performance of a cognitive examination, it is important that the
interpreter refrain from giving hints or extra instructions to the patient
that may defeat the purpose of the test. For example, the “serial
sevens” test is a test of concentration and memory. The exact
instruction varies, but often it is "Take the number 100, subtract 7, and
keep subtracting 7 until I say stop." If this statement is interpreted as
“What is 100 minus seven? [wait for answer] … Please minus seven
again … minus seven again …,” the interpreter is essentially reminding
the patient what to do and therefore limiting the ability of the clinician
to complete an accurate diagnosis.
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Sample challenges
Roma population:
o oral language
o concept of time
o “getting them to understand procedures”
o Lack of engagement and participation
o Feeling of being discriminated
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Sample challenges
Body language:
o Patient not looking at doctors face could be
misunderstood
o Head positioning
o Use of silence
o Smile
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Advancements
Professionalization process
o Development of the Canadian National
Standards for Community Interpreting
Services NSGCIS
o
Development of a standardized postsecondary training for interpreters in
Ontario which is now available to other
provinces online
Multi-Languages Corporation
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Advancements
Canadian Coalition and provincial coalitions
such as the Nova Scotia Coalition and the
Ontario Coalition for interpreting services
Recent creation of a multi tier-accreditation
system for community interpreters in
Ontario
Multi-Languages Corporation
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Conclusion
Lack of public awareness about mental
health and stigma against linguistically
diverse population suffering from mental
illness are wide spread problems in Canada.
There have been several advancements over
the last 20 years to provide better access to
mental health services to linguistically diverse
populations.
Multi-Languages Corporation
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Conclusion
In the future, the country needs to develop
standardized policies to fully support patients
from linguistically diverse communities so
they have equal access to healthcare and
public services.
Multi-Languages Corporation
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