Refugee mental health at risk with cuts, experts warn

The federal government's recent changes to the refugee health program are putting refugees at greater risk of suicide and mental health issues, frontline workers say.
Dr. Nora McBean at a rally on Parliament Hill on June 18, 2012, protesting the cuts to the Interim Federal Health Program. (Sean Kilpatrick/Canadian Press)

The federal government's recent changes to the refugee health program are putting refugees at greater risk of suicide and mental health issues, frontline workers warn.

The new categories of coverage under the Interim Federal Health Program will further stigmatize people with mental health problems and that confusion over the cuts is creating added stress for a population that already has unique mental health challenges, they say.

"I really feel it has aggravated people's mental health issues and there is a high burden of post-traumatic stress disorder and anxiety in this population to start with," said Dr. Meb Rashid, medical director of the Crossroads Clinic at Women's College Hospital in Toronto.

"But then when you're telling people that their children will not be covered for health care or they will not be able to access certain medications, it really is creating a tremendous amount of stress."

The changes came into effect on June 30, and ever since they were announced in the spring by Citizenship and Immigration Minister Jason Kenney there have been ongoing protests since by the medical and refugee communities.

While the protests have focused on the impact on refugees' physical health, the Canadian Psychiatric Association, university psychiatry departments, health care and social service workers are also sounding the alarm about the consequences for mental health.

Rashid, whose clinic specializes in immigration health, said he treats a lot of refugees with depression and post-traumatic stress disorder.

"It's often related to what people's reasons for migration are," he explained.

Stress associated with migration

The stresses associated with migration — isolation, language barriers, low socio-economic status — are in addition to the trauma some refugees experienced before they left home, the advocates say.

"Some of them will have been injured in war, they would have witnessed people dying including family members, they may be survivors of torture, they may be survivors of rape or sexual abuse," said Rob Shropshire, interim executive director of the Canadian Council of Refugees.

Psychological counselling once they arrive in Canada is an important benefit to offer them, Shropshire said.

The refugee health program used to cover psychotherapy and prescription medication — such as anti-depressants — for all refugee claimants, regardless of the status of their application. The program is designed to act as a bridge until provincial health plans can be accessed.

But now only those in the government-assisted refugee category (including refugees referred by the United Nations) will get "the full suite" of mental health services, according to Kenney's office. 

Dr. Meb Rashid, right, is concerned about the impact of the changes to the Interim Federal Health Program on the mental health of refugees. (Women's College Hospital)

Pending refugee claimants are eligible for "the same mental health services as the average Canadian taxpayer receives through their provincial health care coverage," a spokeswoman for Kenney said.

Provinces generally cover psychiatric care but not other kinds of counselling or medications. Under the new federal rules, some refugees can only see a doctor if it's urgent or essential and they will only get mental health problems treated if they are considered to be a risk to public health and safety.

"This restriction serves to further stigmatize our already marginalized patient population, since it deems people worthy of care only if they are dangerous," says a position statement from the University of Toronto’s department of psychiatry.

The Canadian Psychiatric Association also expressed concern about the stigma issue in a letter to Kenney in June and said the restrictions don't address the need for medication and treatment for all patients, regardless of whether they pose a risk.

"We are also concerned about what coverage will be provided for people who are suicidal and require either outpatient or hospital based care," wrote the association's president Fiona McGregor.

The critics say the policy change isn't medically sound and it doesn't make financial sense because untreated conditions will lead to expensive hospital care later.

"Instead of doing all of that preventive work and keeping people well, we're waiting until the inevitable crises happen. That's inhumane, it's unreasonable, it's also very expensive," said Dr. Kwame McKenzie, a psychiatrist at Toronto's Centre for Addiction and Mental Health, Canada's biggest mental health hospital.

'People will end up dead'

There will also be no follow-up care once someone is released from hospital, he said.

"It's suffering that could be avoided and people will suffer," said McKenzie. "And some people will end up dead. That will happen."

John Docherty, co-ordinator of RIVO, a Montreal-based organization that helps victims of torture and violence, is also predicting more suicides because of fewer mental health services.

"It will happen more often I'm sure without that kind of support," he said.

His organization relied on the Interim Federal Health Program for 85 per cent of its funding. It has now had to suspend payment to its psychologists, social workers, and other therapists who last year helped 600 clients.

Members of RIVO's network have been asked to review their caseloads and determine how many people and who they can treat on a volunteer basis while RIVO searches for new funding.

"We're trying now to knit together a bit of a safety net for some people," said Docherty.

He rejects Kenney's justification for the cuts to the IFHP program when the minister talks about giving refugees no more than what most Canadians get.

"We're not talking about most Canadians to begin with," he said, explaining that most Canadians haven't fled war, violence, genocide, sexual abuse or other traumatic events.

Docherty says Kenney's attitude toward refugees is one of "disdain for people seeking protection" and that the government's decision has nothing to do with equity and fairness.

"Jason Kenney cannot open his mouth and talk about refugees without using the words bogus and illegal," he said.

Kenney's office said he was not available for an interview for this story and his parliamentary secretary, Conservative MP Rick Dykstra, was also not available.

Alexis Pavlich, Kenney's press secretary, did say in an email that "activists and opposition politicians continue to purposely mislead Canadians on this issue."

"This is an issue of fairness," she wrote. The government disagrees with "illegal immigrants and bogus refugees … being able to receive gold-plated health care benefits that are more generous than those that Canadian taxpayers receive, including seniors," she said.

Kenney's office was also asked to comment on accepted and pending claimants who are also losing benefits and to respond to the mental health concerns specifically, but no comments were provided.