Art and mindfulness exercises will be used in group settings to help meet the sudden increase in demand due to incoming Syrian refugees, Edmonton psychotherapists say.
Lule Begashaw, team leader of therapeutic services at the Edmonton Mennonite Centre for Newcomers, said the tools will be introduced as a cost-effective alternative to therapy for those requiring mental health services.
The centre currently has seven therapists, mostly part-timers. The wait time to see one is up to eight weeks. By then acute symptoms have often passed, along with the interest of the client, even though their problems continue.
"We don't have enough capacity to address this significant number of people coming right away," Begashaw said. "That's why we are trying to figure out a way we can address this in a larger group and also prevent some of the symptoms from worsening."
Strategy overcomes stigma
The team expects to see post-traumatic stress and mood disorder, anxiety and depression among some refugees.
The strategy is seen as an answer to many of the unique challenges involved in the delivery of mental health services to the hundreds of Syrians expected to arrive in Edmonton over the next few months.
It decreases the need for therapists and translators in one-on-one talk therapy. It also overcomes the stigma, in a culture where seeking mental health supports can be seen as taboo.
"In a group it's less targeted. It's very general," said Begashaw, adding the focus is on prevention, before someone reaches a crisis point. "So it helps in reception of that service. They are more open to receive that."
The use of art could involve a variety of mediums, such as clay, movement, music or drawing, anything that helps a person express emotions and thoughts, explained Begashaw's colleague, psychotherapist Isaac Cherian.
"So that we can be less serious about these serious things," Cherian said. "Because they are already tight and serious."
Learning only happens "when you are at ease. So that will be our general goal. Making the person at ease."
Begashaw saw the powerful healing qualities of art first hand last year while working with a 13-year-old Syrian boy who had "seen a lot of horrible things a child should not see."
In school he would react violently to any slight perception of a threat. Teachers told him to stop drawing big swords and the violent scenes he had witnessed.
But Begashaw said through drawing and journal writing, "he felt safe and he felt more acknowledged in what he has gone through." He is now doing "really well" academically, athletically and socially.
Survival skills from camps no longer needed
While the team is prepared for a variety of mental health issues, they are not quick to diagnose because the behavior could be adaptive rather than pathological.
For instance, said Begashaw, a child having trouble adapting to the routines of a Canadian school may have spent years in a refugee camp where routine means greater risk of robbery or sexual assault.
But survival skills that were useful in the past may now need to change as part of the integration into Canadian society, she said.
Similarly, said Cherian, refugees have developed many coping strategies that ignore personal wishes and needs because they needed to be tough in past situations.
"So when they come here they have these blocks," Cherian said, which can now "be taken down because this is not a war zone."
But the blocks have to be taken down slowly, he added.
Cherian said the goal is to help clients become aware of and express their feelings, wishes and dreams, basically to reconnect with themselves.
The team expects to introduce the mental health tools at informal monthly orientation meetings starting in February, then adjust according to need and interest.
The meetings will give refugees a chance to build social networks with others having similar experiences.
They will also learn the tools of mindfulness, by focusing on an object or their breath, to develop attention and "capacity for self-regulation," said Cherian.
Equine therapy has had some success
Some younger clients could also find themselves grooming a horse, in an equine therapy program first introduced last summer.
Horses usually mirror the emotion of whoever is in front of them, said Bergashaw.
"So if a kid stands in front of them and grooms them, then they would also mirror it so that it increases self-awareness and helps them to self-regulate."
She said they've had "really successful results" seeing children re-learn to connect with others and trust again through equine therapy. "With two or three sessions you see changes in the kids," she said.
Still, Begashaw said there remains a need for more therapists, which is why the centre is applying for additional provincial funding.
She said it's not clear yet how great the need will be, and it will depend on the progress of integration.
"If they get a good welcoming environment and local support to settle, the possibility of having trauma symptoms in the future is lessened," she said.