Supporting Lgbtq Refugees' Mental Health in Canada: Lessons from the Front Lines

Background/Purpose

The documented rise in violence toward sexual and gender minorities globally has prompted researchers and policy-makers to focus on the particular needs of LGBT persons seeking refuge in the West. LGBT refugees tend to enter the host country with a myriad of mental health problems (Alessi, Kahn, & Chatterji, 2016), yet accessing formal treatment and informal social support can be difficult (Kahn, 2015). Although studies of service providers have helped identify facilitators and barriers to the mental health of refugees in general, empirical research has yet to examine these factors for LGBT refugees. The purpose of this qualitative study was to explore the facilitators and barriers to mental health/mental health care for LGBT refugees in Canada in order to contribute to best practice guidelines for professionals and advocates seeking to facilitate the overall welfare of this vulnerable population.

 

Methods

Purposive sampling was used to recruit: 22 Canadian providers (mental health practitioners, settlement workers, legal professionals, community advocates) with at least 6 months’ experience serving LGBT refugees; and 6 LGBT refugees in Canada. Recruitment avenues included community organizations, listservs, and word-of-mouth. Semi-structured interviews spanned 90-120 minutes each, were conducted either in-person or via Skype in English or French, and audio-recorded. Recordings were transcribed verbatim; French interviews were first translated to English. Transcripts were co-coded and analyzed using NVivo software according to grounded theory methods: (a) examination of transcripts for initial ideas/observations; (b) line-by-line coding; (c) focused coding through constant comparison; and (d) theme development. Qualitative results from service providers were triangulated with themes developed from refugee interviews.  Rigor was achieved through moderately prolonged engagement, maintaining an audit trail, member checking, and peer co-coding.   

Findings

Prominent themes included:  (a) uncertainty regarding how to identify, address and/or prevent mental health problems in their clients; (b) assumptions that most symptoms relate to past persecution, potentially obscuring experiences that LGBT forced migrants identify as most traumatic; (c) presumptions about ‘healthy’ expressions of sexualities and identities; and, (d) noting evidence of social isolation and interpersonal relationship stress in their clients. Analysis also revealed that non-mental health providers experienced significant systemic and cultural barriers to accessing formal mental health support for their clients, compounded by: lack of confidence in when to refer; difficulty finding LGBT-affirmative mental health practitioners; concerns that Western-style treatment approaches may conflict with LGBT refugees’ diverse cultural contexts; limited refugee funding for  treatment; and linguistic barriers. Mental health providers in the sample identified lack of knowledge of community-based organizations as a barrier to ensuring informal social support for their clients.

Implications

Findings suggest the importance of empirically-based training interventions to help mental health providers increase their understanding of LGBT refugees, identify cultural barriers that may impede treatment, and establish linkages with LGBT-affirmative community organizations. Additionally, complementary learning opportunities should be implemented for community-based workers in LGBT-related organizations as well as settlement workers who serve the general population of refugees. Future research should engage the target population in informing models of formal mental health care and community-based support that meets their specific needs.