Immigrants and minorities are less likely to get treatment for mental health problems in Canada, and in B.C. experts are chalking it up to the inability of healthcare providers to adapt their services to meet different cultures’ needs.
However, when Ahlay Chin founded the Chinese Mental Wellness Association of Canada, she didn’t need professionals to tell her that.
The Richmond, B.C., office that she works in is a testament to that fact.
A modest space, the walls of the main room are covered in letters of praise from various politicians in her city. A giant banner bearing the organization’s name hangs on the furthest wall. Several volunteers sit at a long table, each of them sorting out a variety of mental health educational materials.
In 1985, Chin's colleague Joe Cheng was laid off from his job at the federal fisheries research laboratory at the University of British Columbia. It was part of a series of federal government closures, and in the following months, Chin noticed her colleague’s mood began to change for the worse.
She thought it was a normal reaction — but later that year, Cheng, his wife and their two children were found dead in their Richmond, B.C., home.
The B.C. Coroners Service ruled Cheng's death a suicide, and the deaths of his family members to be homicides.
A hard lesson
'He lost everything. That made him lose face completely and he ended up not knowing where to go — where to turn to.' —Ahlay Chin, Chinese Mental Wellness Association of Canada
Chin was devastated when she found out about the incident, which stayed on her mind for years.
"I found an answer — it was due to his depression, due to his lack of hope, due to the lack of support," Chin said.
"He lost everything ... That made him lose face completely and he ended up not knowing where to go — where to turn to."
The tragedy eventually led her to start the Chinese Mental Wellness Association of Canada, which has been active for 18 years.
Chin’s mission is to make mental health education and counselling more accessible to members of the immigrant community. But the society’s funding was cut about two years ago.
Researchers and practitioners say it’s an illustration of the inconsistent nature of provincial support for mental health.
Immigrants under treated for depression
'Most of the mental health services that are really addressing cultural and immigrant needs unfortunately have been either . . . eliminated or there have been less and less resources at the regional health authority level.' —Paola Ardiles, author "Towards Reducing Health Inequities"
A national study by Tahany Gadalla, a University of Toronto professor emeritus, says immigrants are over 50 per cent less likely to get treated for depression compared to those born in Canada.
Another study by Hiram Mok, a psychiatrist in B.C, found male Mandarin speakers with 12 years of education have half the chance of getting help for mental health problems compared to non-immigrants.
"Most of the mental health services that are really addressing cultural and immigrant needs unfortunately have been either . . . eliminated or there have been less and less resources at the regional health authority level," says Paola Ardiles, a mental health researcher who chaired the provincial committee that authored the report Towards Reducing Health Inequities, which describes barriers keeping immigrants and minorities from accessing mental health services in B.C.
And while cultural competence training is available, it’s not enough, according to Soma Ganesan, the director of Vancouver Coastal Health's cross-cultural psychiatry program.
'Just a label'
"Some organizations may say we have an excuse, [they] say, ‘I already sent all of my staff for cultural competency training.’ But how much of that translates into services?" Ganesan says.
"Cultural competency, in my view — I’m sorry to be strong on this — is just a label. I do not see much of it translated [into services]."
But B.C.’s piecemeal approach to the problem is just as problematic, Ardiles says.
Cross-cultural services are often provided by non-government organizations, making it hard for the government to measure the success of the programs, according to Ardiles. This lack of information keeps the province from consistently providing funding to cross-cultural services, which face a precarious existence as a result.
A comprehensive strategy implemented at a provincial level is necessary to ensure more consistent cross-cultural services, she says.
In an email, B.C Ministry of Health spokesman Ryan Jabs says the ministry provides funding to each health authority, and "each one has very different geographical, demographic and often cultural make-ups and make decisions based on the needs of their populations."
"There’s not a one-size-fits-all solution."
But Ganesan believes the ministry should consider making it a "core service," meaning the ministry would have to enforce a minimum standard of culturally appropriate services.
He says the minister could work with health authorities, determine the amount of diversity in each of their catchment areas and set the minimum standard accordingly.
The issue highlights a need to change the way mental health services are delivered, says Bev Gutray, who heads the B.C. division of the Canadian Mental Health Association.
'There's not a one size fits all solution.' —Ryan Jabs, spokesman B.C Ministry of Health
"The population of Canada is permanently changed, and our traditional ways of providing services and outreach to the population has to also permanently change," Gutray says.
Back at the office of the Chinese Mental Wellness Association of Canada, Chin reflects on the difficulties she faced when first starting her organization.
"It was very challenging," she says. "People [were] trying to avoid this ... I had to work very hard to try to get people to come."
Looking at the table full volunteers, it appears as if that is slowly starting to change.