Settlement and Mental Health

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Settlement and Mental Health

Quick Facts Concepts, Skills and Terminology How to Learn More Find Services
Head.jpgSettlement workers need to have basic knowledge of mental health. They need to have enhanced capacity to detect early signs of mental health issues in immigrants and refugees, and strengthened ability to connect those at risk to the appropriate services.

Quick Facts

Mental Health in Canada

1. Most newcomers arrive in better health, including mental health, than Canadian-born residents.
2. Overall, newcomers lose their health advantage and their health declines over time.
3. Newcomers have diverse health needs. Certain newcomer sub-populations are at higher risk for specific mental health issues, including women, low income newcomers, some racialized newcomers and refugees.
4. Settlement is a health issue.
5. Newcomers experience multiple barriers to accessing necessary services. This includes access for mental healthcare and services for newcomers to specialists, counselling and therapy, and education and prevention programs.
6. Newcomers' health knowledge and positive behaviours should be acknowledged and promoted.

Social Determinants of Health

  • Social factors may have an influence over a life course to increase or decrease someone‟s risk of developing a mental health problem or illness. Some increase vulnerability while others act as factors that precipitate illness. Some prolong illness and still others prevent illness and restore health.
  • Vulnerability at specific transitions in life, such as during migration, are due to a significant increase in life stresses at a time when the social safety-net may not be as strong.
  • The Public Health Agency of Canada (PHAC) lists 12 determinants of health. With the exception of the biology and genetic endowment determinant, the rest of the 11 of these determinants could be considered social determinants of health and may be particularly pertinent to immigrant and refugee groups. In addition, an important determinant of health that is relevant to immigrants and refugees is their migration experience and immigration category. The Global City: Newcomer Health in 2011

Mental Health and Culture

  • Although mental illnesses have similar symptoms across cultures, their manifestations and how people describe and interpret symptoms vary with ethnicity and culture.
  • For instance, some ethno-cultural groups are more likely to present emotional problems as physical problems.
  • Similarly, stigma within a culture varies according to the cultural and sociological backgrounds of the community.
  • There is evidence that ethnic minorities experience mental illness stigma more harshly than majority groups. Due to family-shared shame, and different cultural perceptions of mental illness and its causes, many members of minority groups delay treatment. Canadian Mental Health Association (CMHA) Ontario.

Concepts, Skills & Terminology

Kwame McKenzie: Diversity and Mental Health

Discover important concepts, definitions and terms relating to mental health in the settlement sector.


  • The WHO (World Health Organization) describes mental health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. It is the foundation for well-being of individuals, families and communities.
  • The WHO defines mental health as “... a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.



Three ideas central to the improvement of health follow from the definition above:

  • Mental health is an integral part of health.
  • Mental health is more than the absence of illness.
  • Mental health is intimately connected with physical health and behaviour.


Supporting Refugee Mental Health

Cultural Competence

Although there is no universally accepted definition of cultural competence, the common elements are the key principles of cultural competence, such as inclusiveness, holistic health, anti-oppression, and valuing diversity have been recommended for practice in settlement service delivery for immigrants and refugees. Ontario Federation of Community Mental Health and Addiction Programs, 2009

Rationale for Cultural Competence in Service Delivery:

  • Ontario’s demographics have become vastly diverse. This diversity goes beyond language and culture.
  • Service providers are finding it increasingly challenging to provide adequate mental health care to diverse populations.
  • Evidence shows differential and inadequate levels of service for particular marginalized populations, resulting in negative health outcomes.Ontario Federation of Community Mental Health and Addiction Programs - 2009

Benefits for Cultural Competence Approach in Service Delivery include:

  • Improved access for underserved groups.
  • Improved service quality.
  • Greater satisfaction with services received.
  • Reduced health disparities.

In order to provide culturally safe services to respond to the diverse needs of Canadians immigrant and newcomer groups, service providers need to communicate and practice in a way that takes into account the social, political,
linguistic and spiritual realities of individuals seeking our support while working in partnership with them. (Mental Health Commission of Canada - 2009).

Some Guiding Principles for Dealing with Mental Health in Settlement Work

The Hong Fook Reference Handbook 2012 includes the following themes, amongst others, in guiding settlement service to immigrants and refugees with mental health challenges:

  • Mental health can be conceptualized in terms of a continuum from wellness to illness instead of discrete states.
  • Empowerment and capacity building.
  • Diversity and cultural competence.
  • Wellness and recovery; and community participation.

Common types of mental illnesses and their signs are described by the Centre for Addiction and Mental Health (CAMH) in the Mental Health and Addiction 101 Series.

How to Learn More

40px-Crystal package settings.png Featured Resource! Journey to Promote Mental Health: A Training Series for Community Workers (Self-directed) - Ontario Council of Agencies Serving Immigrants (OCASI) and Hong Fook Mental Health Association

Further your knowledge with practical guides, best practices, projects and research.

Find out how to become qualified to work in the field through online or classroom-based training.

Best Practices/Practical Guides

This online toolkit is a collection of online training, tools and material to be used by service providers on mental health


Workshop to learn the signs and symptoms of mental illness, and develop the skills and tools for how to best engage with those experiencing mental health challenges.
This workshop helps service providers understand how individuals from different cultures view mental illness, what their understanding of treatment is, and how that impacts the way in which they seek help.
An interactive 2-day training series for settlement service providers, offered across Ontario
A free workshop series for newcomer communities, communities of mental health survivors, mental health services, agencies and institutions.
This workshop teaches strategies for handling challenging personality types and minimizing the impact of their attitudes and behaviors in our lives.
Individual and in-house group training for staff from immigrant service agencies whose positions are funded by Citizenship and Immigration Canada (CIC) and the Ontario Ministry of Citizenship and Immigration (MCI)
This workshop helps individuals identify the main contributors to work/life stress, and learn coping strategies to achieve a sense of balance, satisfaction and success in their family and work lives.

Online Learning

Related Projects/Initiatives

Further Reading

CMHA runs the Working Together: Across Cultures Project. In partnership with community, settlement, and employment organizations CMHA Toronto provides mental health capacity and cultural competency workshops to increase the quality of life of newcomers who are experiencing resettlement stress and mental health issues.

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