Canada prides itself on its open immigration policies and multiculturalism, but what is often overlooked is how much of a toll immigrating, trying to fit into a new country, or facing racism as a newcomer or the child of immigrant parents, can take on your mental health.
A study published late last year in the Canadian Medical Association Journal found that immigrant and refugee youth aged 10-14 in Canada are more likely to visit the emergency room (ER) as their first access point for medical care for mental health concerns than those born within the country.
Researchers looked at almost 119,000 youth who visited an ER for mental health concerns between 2010 and 2014 in Ontario. Slightly more than 61 per cent of the 2,194 refugee youth in the study and 57.6 per cent of 6,680 non-refugee immigrant youth had their first mental health care contact at the ER, compared to 51.3 per cent of Canadian-born youth.
The most common reasons for the visit were substance-related disorders, followed by anxiety disorders, said the study, and the lead study author, Dr. Natasha Saunders, said the results showed that immigrants and refugees may not have the same access to mental health care services as Canadian-born youth.
Watch "People of colour are uniquely affected by mental health issues." Story continues below.
The role of racism and trauma
The existence of racism is often downplayed in Canada, making it difficult to properly assess and tackle how it affects the people it targets.
"Racism is an underlying current that doesn't get its fair share of attention in the Canadian context because we have this rhetoric of multiculturalism," says Zoua Vang, an associate professor of sociology at McGill University who researches racial and ethnic health disparities. "We're told that everybody is on equal footing, but the reality for a person of colour is very different."
Fardous Hosseiny, the national director of research and public policy at the Canadian Mental Health Association (CMHA), said we need to consider the effects — often longterm — that trauma and racism can play in a newcomer's mental health state.
"Many of the people who flee their home country have seen war, violence, or even torture. They may have come from impoverished backgrounds, or faced persecution or discrimination in their country — that has a huge effect on mental health," Hosseiny told HuffPost Canada.
He added that many also lose family members or loved ones during the migration experience.
"Even long after the danger has passed, these frightening events leave signs and symptoms of post-traumatic stress disorder that can last for years," he said.
Some of the symptoms may include flashbacks, nightmares, or difficulty sleeping, said Hosseiny, adding that these symptoms can be exacerbated by isolation, stressing that it's important for people to share their experiences and stories with family members, others in the community, or with a therapist.
Watch "Refugee kids face unique mental health challenges." Story continues below.
The shock of starting over
For many immigrant children or teens, their education is disrupted when they relocate to another country, which can set back learning and development. And, language barriers can discourage some students from speaking up in class, or asking for help if a curriculum is too fast-paced, which creates a void of academic support.
In addition to language barriers, which might affect learning, bullying can and often does have a profound impact on a child's well-being.
"Being shunned or excluded because you are different impacts not just a child's or teenager's sense of self-worth, but can impact their belief systems about the world, and can encourage them to turn against their own culture," Diviya Lewis, a psychotherapist, told HuffPost Canada.
Lewis knows this experience all too well. She moved to Canada from India with her family when she was five years old.
"Because I was picked on as a kid, I would accuse my parents of being 'too brown,' and would feel myself get embarrassed by them," she said.
Lewis said bullying can affect one's self-esteem and self-confidence well into adulthood if someone isn't counselled at the time or doesn't have support.
"It's up to parents, teachers and educators to foster space for kids and young people to feel safe to open up, to teach their kids about the impact of bullying, to recognize the signs of bullying — withdrawal, nightmares, atypical acting out, unexplained crying or reverting back to stages that they've moved past — and to help them open the conversation," said Lewis.
Forced career changes
Hosseiny noted that adults also face major disruptions in their careers when they relocate.
"As part of the acculturation process, there's a huge decline in socioeconomic status for some immigrants," said Hosseiny. "Their skills and education may not be transferable. What they had back home, such as being well-employed for the skills that they studied for, is not recognized when they come here. That can negatively affect a person's mental health."
And because of this, children of immigrants can feel guilty and pressured when they see the economic challenges their parents face, he added.
"They see their parents trying to make ends meet and they're affected by that, he said. "It can be a source of sadness or depression."
Second-generation Canadians are affected differently
Language may be less of a barrier for people who are born and raised in Canada, but there are other struggles that can lead to distress.
"Growing up, second-generation Canadians may feel even more of a clash in a sense because they're being taught one thing in the school system and by society — that they're equal — and yet, in their daily lives, they're treated as if they're the 'other,'" saidZoua Vang.
She noted that this dual experience can cause underlying stress that affects mental health. This can lead to feeling alienated and can cause children of immigrants to act out in ways they may not be conscious of.
"This could be reflected in only having white friends, or saying disparaging things about their own (cultural) groups. They might buy into racist ideologies that the dominant (cultural) groups are saying about them, that they are inferior."
And there's the added layer of finding an identity between those of their parents' culture of origin while maintaining the culture they were brought into, said Hosseiny.
Lewis battled trying to straddle both of these cultural worlds, she said.
"Some of the messages and beliefs that were ingrained into me by my parents, were that 'You have to work hard, because nothing is handed to you', 'You have to do whatever it takes to get your foot in the door, and you must work your way up.' It doesn't matter what you want or like, you have to fit in with the system. At the same time, I was also exposed to messages through teachers, friends, and their parents about how special I was, and that what I want matters," said Lewis. "So I was constantly pulled in two directions."
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Besides the fact that mental health-care services in Canada are often not available in a person's native tongue, there's also a stigma associated with mental illnesses in many cultures. Hosseiny said there is still a need for mental health literacy in many cultures.
Immigrant parents, and subsequently, their children, are often raised not to show weakness, so their mode of coping involves "sucking it up" and "doing the right thing."
"Often, it's something that's not talked about at all. When you're sad, the common language is: 'Why are you sad? Just get over it. Some of your family back home are dealing with war. What right do you have to be depressed?'" said Hosseiny.
But that's not how depression works.
"Yes, it's upsetting your cousins back home are dealing with bombs on a daily basis, but your depression and mental health is not correlated with what your cousins are dealing with back home. It's your own personal illness," he added.
Lewis said that as a therapist, when working with youth from various cultural backgrounds, the two most common areas of focus for her are to find ways to alleviate their guilt and longstanding shame and assertiveness training to help them advocate for their needs.
"In their families growing up, their emotional needs are often not a main priority, they're taught to not question authority, so assertiveness training is necessary in a culturally sensitive way," she said. "Emotional awareness, compassion, and forgiveness are so important."
For many, schools or universities are the first opportunity they have had to even consider their mental health, said Lewis.
"It might not be openly spoken about in their homes, churches/mosques/temples etc., so we sometimes saw deep-rooted trauma emerge for the first time. We need to create an environment where newcomers are aware of the support systems that exist and how to access them."
Are you in a crisis? If you need help, contact Crisis Services Canada at their website or by calling 1-833-456-4566. If you know someone who may be having thoughts of suicide, visit CAMH's resource to learn how to talk about suicide with the person you're worried about.
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