EHR and practice management for mental / behavioral health

Mental Health Services in Canada: Immigrants and Refugees

by Jerica Rossi, 10.3.18

With such a high percentage of immigrant and refugee populations, it’s vital for Canadian mental health providers to understand how cultural factors affect mental health services – as culture plays a large role in how we perceive health and wellness. When looking at immigration, for example, clinicians should be aware of the difference between Canadian perceptions of mental health and the mental health perception of an immigrant’s native culture.

The Screening Process

Currently, immigrants make up more than 20% of Canada’s population, with 1 in 5 people in Canada being foreign born (Government of Canada, Statistics). Prior to entering Canada, immigrants and refugees must undergo a health screening to determine if their presence will in any way become burdensome to the Canadian health system, which operates as a free service to all citizens and is funded by tax dollars.

The multi-layered screening process for Canadian refugees is as follows:

  1. Refugee identification before referral to IRCC: In conjunction with the United Nations Refugee Agency (UNHCR), refugees are prioritized by low security risk, such as women and complete families.
  2. Immigration and security interview by experienced visa officers: An applicants’ information is validated
  3. Identity and document verification/ biometric and biographic collection
    1. The following information is collected by Immigration, Refugees and Citizenship Canada (IRCC) from the applicant at the session where biometrics are enrolled:
      1. Biographic data: Name, date of birth, and other personal details of an applicant as listed on the biographic data page of the applicant’s passport or travel document.
      2. 10 fingerprints: Fingerprints of the applicant, captured electronically during the biometrics collection session, using an electronic fingerprint-capture device.
      3. Photograph: A digital photograph of the applicant.
  1. Health screening: A full medical exam is conducted, including screening for contagious diseases PRIOR to their arrival in Canada
  2. Identity confirmation prior to departure for Canada
  3. Identity verification upon arrival and final health check: Upon arrival,all refugees are screened for signs of illness and treated if necessary. They also are eligible to receive health services before moving on to their new community if temporarily housed (Source:

Clinical Treatment of Immigrant + Refugee Populations

When working with migrant populations, mental health professions should a) be familiar with their patient’s country of origins and that cultures’ perceptions of mental health and b) be familiar with the immigration process of their patient – as it has many different faces – and how that process might impact the client’s mental health needs.

For some, such as refugees, their journey to Canada may have involved a fair amount of trauma, as they may have been fleeing from religious persecution, genocide, war or famine.

Additionally, do they come from a culture where doctors are associated with fraud and are untrustworthy? Are there gender norms for who can provide them treatment? Do they usually talk with a religious leader or family member instead of a doctor? Is their experience of health deeply spiritual?

Understanding these pre-migration factors and a patient’s cultural perceptions of health increases the likelihood of effective communication between patient and health care professional, setting the stage for a proper diagnoses and appropriate treatment.

The book The Spirit Catches You and You Fall Down by Anne Fadiman is a widely acclaimed narrative within the medical field that provides an in-depth narrative of how cultural differences and misunderstandings can obstruct medical treatment.

For those looking to become more familiar with cross-cultural issues in the mental health field, this book touches on the convergence of indigenous medicine, Western medicine, cultural values and the patient-physician relationship.

*See below for additional resources related to immigrant health services in Canada.

Post-Migration Factors 

Research has shown that immigrants appear to be mentally healthier than their Canadian counterparts upon arrival, exemplifying resilience and being mentally/physically capable of moving their family to a new country. However, over time, their health tends to decrease.

Assimilation is a multi-faceted endeavor which may require the acquisition of a new language, obtaining steady employment and/or adapting to an unfamiliar education system Navigating these elements of assimilation is no easy task on a socio-emotional level and can often result in feelings of isolation, which can be detrimental to one’s mental and physical health.

Clinicians should be aware that accessibility to health services, and a provider’s responsiveness to immigrants’ health, can also hinder successful assimilation. Perhaps they can’t effectively communicate what their issue is; it’s a taboo topic; they are unsure of how to access care; and/or don’t feel like a health professional would understand their perception of their needs.

Resources for Practitioners

The Affiliation of Multicultural Service Providers (AMSSA)

Multicultural Mental Health Resource Centre (Check out their webinar section!)

When medicine and culture intersect


Immigration and Ethnocultural Diversity in Canada

Cross-cultural Mental Health and Substance Use

(Photo by Kenia Makagonova via Unsplash)

Jerica Rossi is a Marketing Associate of PIMSY EHRJerica Rossi is a Marketing Associate of PIMSY EHR. For more information about electronic solutions for your practice, check out Behavioral Health Practice Management Software.

Author: pehradmin

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