An Evaluation of Accessibility Barriers in Mental Health Services for Immigrant and Refugee Children and Youth

Background: Every year, 40,000 new immigrants arrive in by British Columbia (BC). According to the 2006 Census, immigrant children comprised 7.7% of the total child population in BC, which has the second highest proportion of immigrant children in Canada, second only to Ontario. Of the 23,056 refugees who arrived in Canada in 2012, 11% of the 7300-7500 government assisted refugees resettled in BC.  Immigrant and refugee children and youth require a spectrum of mental health services; indeed, they may require more services as many have endured violence, trauma, escape from war-torn countries, stigma, and poverty. Given their sizable numbers and obvious need for support, surprisingly little study of the needs of mental health needs of refugee and immigrant youth has been conducted. A recent Canadian Mental Health Association report recognized the need to “prioritize initiatives that support vulnerable groups such as...immigrant and refugee youth” (2014, 4). The purpose of this study was to better understand barriers to child and youth mental health services experienced by immigrant and refugee children and youth in BC.

Methods: This study utilized a concurrent mixed methods approach. Data were collected through surveys, semi-structured interviews, and focus groups. A purposive/theoretical sampling method was initially used to reach participants “based on their ability to provide needed information” (Padgett, 1998, 51), and later a snowball sampling method was utilized to increase response rate. Survey respondents included 18 Children and Youth mental health (CYMH) workers and child welfare workers. Nine individual interviews and one focus group were conducted. Participants included: five CYMH clinicians, three community stakeholders, and one representative from a school-based program. Surveys and interviews sought information about access barriers experienced by immigrant and refugee children and youth.

 Results: Notably, 72% of survey participants disagreed or strongly disagreed that “Most immigrant and refugee children are able to receive MH services in their preferred language,” while 67% disagreed or strongly disagreed that “Mental health services for I/R children are integrated and cohesive.” Only 39% of respondents reported that MH services integrate the spiritual and religious practices and beliefs of youth into their care. The following seven barriers were identified by survey, interview, and focus group participants: 1) stigma; 2) language; 3) mental health awareness; 4) lack of infrastructure to support culturally sensitive practices; 5) trauma; 6) fear of government bodies; and 7) immediate family needs that take priority over seeking mental health support.

Implications:  Recommendations of study participants included: 1) approaching this population with cultural humility; 2) developing specialized clinician outreach roles; 3) partnering with neighborhood houses and other immigrant/refugee agencies to facilitate access to MH services by working with parents; 4) exploring school-based MH service delivery, which is common in the U.S. but underutilized in BC;   and 5) enhancing data analytic capacity to track service to these youths.