MH problems Flashcards
why difficult to treat their MH problems 10
differences in language, cul-
ture, patterns of seeking help and ways of coping
specific stressors
associated with migration and resettlement like shaping of symptoms and illness behaviour on
diagnosis, coping and treatment; differences in family
structure and process affecting adaptation, acculturation
and intergenerational conflict; and aspects of acceptance
by the receiving society that affect employment, social sta-
tus and integration.
The migration trajectory can be divided into three
components
premigration, migration and postmigration
resettlement. each phase is associated with specific risks
and exposure
The prevalence of specific types of mental
health problems is influenced by …
the nature of the migra-
tion experience, in terms of adversity experienced before,
during and after resettlement.
Clinical assessment and treatment effectiveness can be
improved with the use of … when linguistic and cultural differences impede
communication and mutual understanding.
trained interpreters and culture
brokers
Rates of mental disorders vary in different migrant groups,
but these differences do not simply reflect the rates in the
countries of origin what is it then
prevalence of specific types of
problems and rates of health care use in particular groups can
be linked to migration trajectories in terms of adversity expe-
rienced before, during and after resettlement and to policies
and practices that determine who gains admittance to
Canada e.g. status in country, trauma, children
Postmigration factors that moderate the
effects of premigration stress and that ensure … are especially important in ensuring good
health outcomes
employment and economic stability
the health of immi-
grants tends to be better than that of the general population in
both the sending and receiving countries t or f
t (Rates in immigrants varied by region of origin,
with the highest rates found among immigrants from Europe
and the lowest among those from Africa and Asia?)
why healthy imm effect
must pass through a variety of filters to achieve
immigrant status
the health of immigrants tends to
worsen over time to match that of the general population.`
t
exception to healthy immigrant rule
refugees are at substantially
higher risk than the general population for a variety of spe-
cific psychiatric disorders — related to their exposure to war,
violence, torture, forced migration and exile and to the
uncertainty of their status in the countries where they seek
asylum
some groups of migrants have
an elevated incidence of psychotic disorders after migration who and why
suggesting that racism and discrimination
have a role in elevated incidence
Migration involves three major sets of transitions: …
changes
in personal ties and the reconstruction of social networks, the
move from one socio-economic system to another, and the
shift from one cultural system to another
The migration
trajectory can be divided into three components
premigra-
tion, migration and postmigration resettlement (sepcific risks and exposures at each stage
pre risks ?
premigra-
tion period often involves disruptions to usual social roles and
networks.
during risks ?
immigrants can experience pro-
longed uncertainty about their citizenship status as well as sit-
uations that expose them to violence e.g. asyulum seekers worse MH
post risks ?
resettlement usually brings
hope and optimism, which can have an initially positive effect
on well-being. Disillusionment, demoralization and depression
can occur early as a result of migration-associated losses, or
later, when initial hopes and expectations are not realized and
when immigrants and their families face enduring obstacles to
advancement in their new home because of structural barriers
and inequalities aggravated by exclusionary policies, racism
and discrimination.
give an example of pre, migration and post factors related to MH
Economic, educational and occupational
status in country of origin/ Trajectory (route, duration)/ Uncertainty about immigration or
refugee status
main
domains of resettlement stress include …6
social and economic
strain, social alienation, discrimination and status loss, and
exposure to violence
Risk factors
for mental health problems can differ for men and women give eg
language more impact on men MH
how often do they seek help
less then can counterparts
why less help seeking
structural and
cultural barriers, including the lack of mobility or ability to
take time away from work, lack of linguistically accessible
services, a desire to deal with problems on one’s own, the
concern that problems will not be understood by practitioners
because of cultural or linguistic differences, and fear of
stigmatization.
MH of adol and children?
dif findings of risk for disorders (worse for refugees distress and dep), post mig= accul-
turative stress and family poverty
earn a new
language, renegotiate their cultural identity, and deal with
social isolation, racism, prejudice and discrimination. 83 As
youth acculturate, many come into conflict with parents and
relatives
ow to support youth
Postmigration factors, includ-
ing the quality of reception and support in the country of asy-
lum, are important predictors of long-term outcome
women issues?
The many roles and responsibilities of immigrant women in
the home and the workplace can impede their access to men-
tal health services, more postpartum
Refugee women seen in specialized clinics have high rates
of exposure to violence and post-traumatic stress disorder
senior issues/ risks?
female sex, less education, unemployment, poor self-rated
health, chronic diseases (heart disease, diabetes, asthma),
widowhood or divorce, and lack of social support or living
alone
join fam = slower rates of learning the language and accul-
turation; separation from extended family, peers and familiar
surroundings; decreased social support and isolation because
extended family and community networks are lost; increased
dependency on others because of language and mobility diffi-
culties; fewer opportunities for meaningful work and produc-
tivity; and loss of status as a respected elder in the new cul-
tural context.
Which clinical strategies are effective?
generally same strat but communication, cultural shap-
ing of symptoms and illness behaviour, the effect of family
structure and process on acculturation and intergenerational
conflict, and the receiving society’s facilitation of or imped-
ance of adaptation and social integration
Culture
can profoundly influence every aspect of illness and adapta-
tion, including ….
interpretations of and reactions to symptoms;
explanations of illness; patterns of coping, of seeking help
and response; adherence to treatment; styles of emotional
expression and communication; and relationships between
patients, their families and health care providers
Place of origin can affect …3
exposure to endemic diseases,
childhood immunization and health care experiences
they think such stressors are inap-
appropriate topics for medical attention or they believe that their
situation will not be understood how to overcome
elicited by enquiring
about the effect of the physical symptoms or other presenting
concerns on activities of daily living, stressors, social supports,
functioning in work and family, or community contexts
medication issues
need to ask if using other trad remedies questions about previous or ongo-
ing consultations with a physician, healer or helper from
their own or other communities can uncover medication use
or other health concerns that can affect adherence, treatment
response and coping
… has been identified as one of the most important barri-
ers to accessing services for newcomers
Failure to use inter-
preters (professional not casual)
Except in urgent situations where there is no alternative,
family members or untrained lay people should not be used as
interpreters t or f
t
family members should be excluded for prpivacy
f It is important to acknowledge and
welcome family members who accompany the patient. provide support build trust etc
the cultural legiti-
macy of …. For counselling and treating youth, interventions
should be framed in ways that avoid alienating family mem-
bers or aggravating intergenerational conflicts
parental authority over adolescents should be taken
into account
Becoming familiar with existing … can help practitioners identify
and mobilize psychosocial support and other resources
when needed
community org
Migrant youth living in communities with a high proportion
of immigrants from the same background are worse off
f better
adjusted, partly because they have positive role models, a
stronger sense of ethnic pride and social support, which can
help them deal with the stressors of poverty, discrimination
and racism
In urban centres with large immigrant populations, com-
munity resources can be divided into two broad categories:
multiethnic organizations that offer services related to settle-
ment and integration, and groups specific to various ethnic
backgrounds that provide a sense of belonging and support
for a particular ethnocultural identity. why important
must understnad what they identify with before referral
