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Armchair Discussions Canadian School of Public Service Ottawa 28 February 2008. Immigration and Mental Health . Nazilla Khanlou, RN, PhD 1 1 Health & Wellbeing Domain Leader , CERIS – The Ontario Metropolis Centre

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immigration and mental health

Armchair Discussions

Canadian School of Public Service


28 February 2008

Immigration and Mental Health

Nazilla Khanlou, RN, PhD1

1 Health & Wellbeing Domain Leader , CERIS – The Ontario Metropolis Centre

Associate Professor, LSB Faculty of Nursing & Department of Psychiatry, University of Toronto

  • Context (Immigrant population, Newcomer youth)
  • Mental health (What is it?, Healthy immigrant effect)
  • Resilience (Why is it important for mental health?)
  • Research example
  • Discussion

Immigrant Population

Newcomer Youth

immigration 2006 census
Immigration – 2006 Census
  • Over 6 million foreign-born (close to 20% of population); highest proportion in 75 years
  • Between 2001-2006, over 1 million immigrants to Canada
  • Approximately 60% of newcomers from Asia (compared to 12% in 1971), 16% from Europe (62% in 1971), 11% from Central and South America, and 11% from Africa
  • Over 70% of foreign-born mother-tongue other than English or French (over 18% Chinese, over 6% Italian)
  • Close to 70% of recent immigrants in Toronto, Montreal and Vancouver
  • Most foreign-born (85%) eligible for Canadian citizenship, naturalized

Note: Numbers above have been rounded.

Statistics Canada. (2007). 2006 Census: Immigration, citizenship, language, mobility and migration. The Daily: 4 December 2007.Available URL:

newcomer youth
Newcomer Youth
  • Children and youth make up a significant portion of immigrants into Canada
  • Over last decade (1997-2006)
    • 0 to 14 years (over 20% each year)
    • 15 to 24 years (over 13% each year)
  • In 2006
    • 0-14 years/2006 = 51,320 (20.4% of 251,649)
    • 15-24 years/2006= 40,674 (16.2% of 251, 649)

Citizenship and Immigration Canada. (2007). Facts and Figures 2006. Immigration Overview: Permanent and Temporary Residents 2006.Available URL:

mental health
Mental Health

What is it?

Healthy immigrant effect

mental health7
Mental Health
  • Without mental health there is no health
  • More than the absence of mental disorders
    • “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”
  • Determined by socio-economic and environmental factors
  • Linked to behaviour

World Health Organization. (2007). Mental health: Strengthening mental health promotion. Fact Sheet # 220. Available URL:

mental health promotion
Mental Health Promotion
  • “... the process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. Mental Health Promotion uses strategies that foster supportive environments and individual resilience, while showing respect for culture, equity, social justice, interconnections and personal dignity.”

Centre for Health Promotion. (1997). Proceedings from the International Workshop on Mental Health Promotion. University of Toronto. In C. Willinsky, & B. Pape. (1997). Mental health promotion. Social Action Series. Toronto: Canadian Mental Health Association National Office.


Theoretical Perspectives

  • Approaches to examining immigrant health:

1. Morbidity-mortality hypothesis

2. Healthy immigrant effect

3. Transitional effect

Alati, R., Najman, J.M., Shuttlewood, G.J., Williams, G.M., & Bor, W. (2003). Changes in mental health status amongst children of migrants to Australia: a longitudinal study. Sociology of Health and Illness, 25(7), 866-888.


For a critique of sick immigrant and healthy immigrant paradigms see:

Beiser, M. (2005). The health of immigrants and refugees in Canada. Canadian Journal of Public Health, 96(Supplement 2), S30-S44.

healthy immigrant effect
Healthy Immigrant Effect
  • 2000/01 Canadian Community Health Survey
  • Immigrants lower rates of depression and alcohol dependence than Canadian-born
  • Healthy immigrant effect strongest among recent immigrants and immigrants from Africa and Asia (most recent immigrants from Asia and Africa)
  • Long term immigrants similar rates of depression as Canadian-born (most long term immigrants from Europe)
  • Findings consistent with those on physical health (immigrants in better physical health than Canadian-born)

Ali. J. (2002). Mental Health of Canada’s Immigrants. Supplement to Health Reports, volume 13, Statistics Canada, Catalogue 82-003, 1-11.

healthy immigrant effect11
Healthy Immigrant Effect

“Although it is clear that there are vulnerable sub-groups among immigrants, it appears that most immigrants, particularly recent immigrants, exhibit fewer mental health problems than the Canadian-born population. Whether this pattern reflects greater resiliency or a difference in how immigrants approach stress and adversity in their lives is a question that could be addressed in future research.” (Ali, 2002, p. 6)

Ali. J. (2002). Mental Health of Canada’s Immigrants. Supplement to Health Reports, volume 13, Statistics Canada, Catalogue 82-003, 1-11.

newcomer youth12
Newcomer Youth
  • Important to distinguish between status
    • Immigrant
    • Refugee
    • Precarious status
  • Also helpful to distinguish between phases
    • Pre-migration
    • Migration
    • Post-migration

Khanlou, N. (2007). Young and new to Canada: Promoting the mental wellbeing of immigrant and refugee female youth. International Journal of Mental Health & Addiction. (Online:

Khanlou, N., & Guruge G. (2008). Chapter 10: Refugee youth, gender and identity: On the margins of mental health promotion. In: Hajdukowski-Ahmed M, Khanlou N, & Moussa H(Editors) Not born a refugee woman: Contesting identities, rethinking practices. Oxford/New York: Berghahn Books (Forced Migration Series).

mental health mental health promotion immigrant receiving and multicultural societies
Mental Health & Mental Health PromotionImmigrant receiving and multicultural societies
  • Mental health: a sense of mental well-being arising from interaction between individual and environment. Intersections of micro (e.g. health status, social networks) and macro (e.g. neighbourhoods, political instability, globalization) level influences.
  • Intersections of gender, life stage, cultural, migrant and racialized status on mental health promotion in multicultural settings must be considered.

Khanlou, N. (2003). Mental health promotion education in multicultural settings. Nurse Education Today, 23(2), 96-103.

Khanlou, N., Beiser, M., Cole, E., Freire, M., Hyman, I., Kilbride, K.M. (2002). Mental health promotion among newcomer female youth: Post-migration experiences and self-esteem. Ottawa: Status of Women Canada.


Why is it important for mental health?

defining resilience
Defining Resilience
  • Capacity to “cope with, and bounce back after, the ongoing demands and challenges of life, and to learn from them in a positive way” (Joubert & Raeburn, 1998)
  • Positive adaptation to adversity; not the absence of vulnerability (Waller, 2001)
  • Is “a class of phenomena characterized by good outcomes in spite of serious threats to adaptation or development” (Masten, 2001)

Joubart, N., & Raeburn, J. (1998). Mental health promotion: People, power and passion. International Journal of Mental Health Promotion, Inaugural issue, September, 15-22.

Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56(3), 227-238.

Waller, M.A. (2001). Resilience in ecosystemic context: Evolution of the concept. American Journal of Orthopsychiatry, 71(3), 290-297.


Growing Up Resilient: Ways to Build Resilience in Children and YouthBarankin, T., & Khanlou, N. (2007). Toronto: CAMH (Centre for Addiction and Mental Health).

systems involved
Systems involved




Barankin & Khanlou (2007)

environmental factors
Environmental Factors
  • Inclusion
    • Having a sense of belonging
      • Gender
      • Culture
  • Social conditions
    • Society promoting resilience
      • Socio-economic situation
      • Media influences

Barankin & Khanlou (2007)

environmental factors continued
Environmental Factors (continued)
  • Access
    • Systems promoting resilience
      • Education
      • Health
  • Involvement
    • Youth’s participation in the world around them

Barankin & Khanlou (2007)

environmental examples of protective factors
Environmental – examples of protective factors
  • Policies (local to national) promoting equity, justice, inclusion
  • Access to community resources (e.g. public transportation)
  • Supportive and safe school environments
  • Living in a safe and caring neighbourhood
  • Access to counsellors & mental health & addiction services as needed
  • Positive media messages
  • Contact with caring adults (e.g. teachers, coaches, etc)
  • Links to strong cultural community (sense of history, feelings of belonging)
  • Involvement in healthy physical, recreational, and volunteer activities

Barankin & Khanlou (2007)

putting it all together
Putting it all together
  • Resilience is developed within the context of multiple systems.
research example
Research example

Newcomer Youth


Newcomer Youth StudyKhanlou, N., Beiser, M., Cole, E., Freire, M., Hyman, I., & Kilbride, K.M. (2002). Mental health promotion among newcomer female youth: Post-migration experiences and self-esteem/ Promotion de la santé mentale des jeunes immigrantes: Expériences et estime de soi post-migratoires. Ottawa: Status of Women Canada .


Self-conceptKhanlou, N., & Crawford, C. (2006). Post-migratory experiences of newcomer female youth: Self-esteem and identity development. Journal of Immigrant and Minority Health, 8(1),45-56. [Figure 1: Self-concept theme and sub-themes, p. 50]

  • Friends
    • Ya, because we are still ESL students, sometimes we can’t speak English very well, and then, those maybe Canadian born or those English speakers don’t really talk to us, sometimes, but they do but not much. (P2, FG1)
systems issues
Systems issues

“She feels different because in certain occasion children make her feel different. You know, her hair is different of course, her colour is different than other children, and she had an accent, but she doesn’t have the accent now, ya, but she had an accent. And you know, and always being asked where do you come from?” (PA3, PI2)

systems issues27
Systems issues

“Because, I mean if you, you think if kids come with parents who are doctors and nurses and they come here. Parents have to end up in factory, they’re frustrated, that frustration is passed on to the children as well.” (S2, Meeting with SEPT workers)

key findings
Key Findings
  • Important role of gender in settlement experiences of newcomer immigrant youth.
  • Language barriers significantly influenced different aspects of youths’ lives (e.g. school outcomes, peer relationships).
  • Discriminatory attitudes and family settlement barriers can impact youths’ mental health.
  • Despite challenges, youth had positive outlook on their future and high motivation for educational and career success.
  • 15 policy recommendations made addressing: education system, health and social services systems, resettlement services, and across-systems.
policy recommendations health social services systems
Policy Recommendations: Health & Social Services Systems
  • Educate health & social services professionals working with newcomer female youth in cultural sensitivity.
  • Across the health system, provide appropriate MHP initiatives for newcomer female youth.
  • Focus on strengths of newcomer female youth as well as their challenges. Foster youth participation in decision-making fora related to health & social services planning.
policy recommendations across systems
Policy recommendations: Across Systems
  • Develop and co-ordinate partnerships (including health, education, social and resettlement services) across systems.
  • Adopt culturally sensitive, anti-discriminatory policies and strategies in institutions that work with newcomer female youth and their families.

Thank you!

contact information

Contact Information

Nazilla Khanlou

CERIS – The Ontario Metropolis Centre

University of Toronto