Lucie Nadeau

Addressing trauma in collaborative mental health care for refugee children

Primary care institutions, including clinics, schools and community organizations, because of their closeness to the family living environment, are often in a privileged position to detect problems in traumatized refugee children and to provide help. In a collaborative care model, the child psychiatrist consultant can assist the primary care consultee and family in holding the trauma narrative and organizing a safe network around the child and family. The consultant can support the establishment of a therapeutic alliance, provide a cultural understanding of presenting problems and negotiate with the consultee and the family a treatment plan. In many settings, trauma focused psychotherapy may not be widely available, but committed community workers and primary care professionals may provide excellent psychosocial support and a forum for empathic listening that may provide relief to the family and the child.

Refugee Children and Their Families: Supporting Psychological Well-Being and Positive Adaptation Following Migration

The support of refugee children and their families is a worldwide concern. This article will highlight models of mental health care for refugee children and their families, focusing on collaborative care with primary care providers. Case vignettes are provided to illustrate how collaborative care can support refugee children׳s psychological well-being and positive adaptation following migration.

A mix-method approach to the cultural understanding of distress and the non-use of mental health services

Background: The rationale for conducting mixed-method studies is usually based on the desire to combine the complementary strengths of qualitative and quantitative research. Typically, the former provides in-depth descriptions offering strong internal validity while the latter provides strong external validity. The exclusive use of quantitative methods in mental health research presents certain limitations which lie in the subjective nature of mental health problems and related behaviors, and the fact that these are mediated by cultural context. Aims and methods: This paper illustrates, along with the Pathway and Barriers to Mental Health project, the usefulness of using a mixed-method design to study mental health problems and related behaviors in a culturally diverse community. Results: The results show how the various quantitative and qualitative stages of the project were implemented in a Sequential Transformative Design that allows for a better identification and understanding of community mental health problems. This type of mixed design contributed to the development and evaluation of a regional cultural consultation service in mental health. Conclusion: A mixed-methods approach does not simply make positivist science stronger; rather, it contributes to do better research and tailored intervention.

Addressing Cultural Diversity Through Collaborative Care

This chapter describes principles of collaborative care in mental health and how this model, based on strong partnership between primary care and mental health professionals, can be adapted to provide culturally sensitive services. The patient-centred model of collaborative care aims at decreasing barriers to accessing mental health care, which are particularly tangible for ethnocultural minorities and marginalized groups. It recognizes the major role played by primary care professionals in delivering mental health services and the benefit of comprehensive networks of professionals and community partners. The chapter discusses necessary conditions for implementing such initiatives, describes the benefits of multidisciplinarity, which goes beyond a medically centred model, and addresses issues of power. It then considers the adaptation of collaborative care to address the cultural specificities of communities. It reviews the recommendations of the Canadian Collaborative Mental Health Initiative (CCMHI) Toolkit for Ethnoculturally Diverse Populations and of the Canadian Collaboration for Immigrant and Refugee Health (CCIRH), and then focuses on two key areas identified by these recommendations: partnership with communities and awareness of historical and cultural specificities. The chapter then describes a youth mental health care project in a multiethnic neighbourhood to illustrate how collaborative care can be adapted to local constraints, while fostering attention to cultural diversity in mental health. Finally, the chapter addresses training methods appropriate to support collaborative care and proposes a continuing education program based on the synergy of seminars, supervisions, and didactic teaching.

Consultation to Remote and Indigenous Communities

Most models of mental health services have been developed in urban centres, with large populations and many specialized resources. Rural and remote communities pose challenges to these models for reasons of geography, social structure and culture. In Canada and other countries, rural and remote communities include a high proportion of Indigenous peoples, with important cultural differences from the urban population. In this chapter, we discuss the role of cultural consultation in providing mental health services for remote and rural communities, with an emphasis on the mental health of Indigenous peoples in Canada. The authors have worked as psychiatric consultants to First Nations and Inuit communities in Northern Quebec and draw from this experience and the work of the CCS to outline key issues for cultural consultation in this setting. The major social determinants of health and contextual factors that are distinctive for remote communities and Indigenous populations are reviewed. Models of service discussed include: onsite delivery of mental health services through collaborative care models; itinerant consultants; telepsychiatry; and satellite services. Mental health services for Indigenous communities need to be provided in culturally appropriate ways, both through supporting the use of traditional healing approaches and ensuring that mainstream mental health services are culturally safe and competent.

Perspectives of Migrant Youth, Parents and Clinicians on Community-Based Mental Health Services: Negotiating Safe Pathways

Youth mental health (YMH) services are greatly underutilized, particularly for migrant youth. Collaborative models of care offer promising avenues, but research on these treatment modalities is still scarce, particularly for migrants. The goal of this exploratory study is to better understand quality of care including factors improving access to care and collaborative YMH services use, efficacy and satisfaction, for this vulnerable population. This qualitative study relies on a multi-informants (youth, parents, clinicians) and multiple case study design to explore YMH collaborative services for migrant youth living in an urban setting (Montreal, Canada). Participants are five young patients (12–15 years old), one of their parents and their primary care therapist (N = 15). They come from migrant families, have a psychiatric diagnosis and have been receiving mental health services in a collaborative care setting for at least 6 months. Transcripts of semi-structured interviews for the five triads were thematically analyzed to draw similarities and contrasts between actors, across and within case-studies. Based on these findings, four themes emerged concerning the optimal care setting for collaborative YMH services for migrant families: (1) providing an equilibrium between communication, collaboration and privacy/confidentiality, (2) special attention to ensuring the continuity of care and the creation of a welcoming environment where trusting relationships can develop, (3) the inclusion of family intervention, and (4) the provision of collaborative decision-making pathways to care, addressing interprofessional and interinstitutional collaboration as well as cultural differences in explanatory models and values.

Cultural Consultation in Child Psychiatry

This chapter addresses cultural consultation in child psychiatry. The mental health needs of immigrant and refugee youth are outlined, and different models of mental health services for immigrant and refugee children and their families are described. The work of two transcultural child psychiatric teams, one in Canada and one in France, are presented in order to illustrate the practice of transcultural child psychiatry. The aim is to outline practical strategies for consultation and intervention, and also to show how specific institutional, social and political contexts influence how clinicians address issues associated with minority status and culture in their cultural consultation work. The chapter concludes with some reflections on how sociocultural context influences the practice of transcultural child psychiatry in these two models of care.

Collaborative youth mental health service users, immigration, poverty, and family environment

Background This article examines the association between immigration, poverty and family environment, and the emotional and behavioral problems reported by youth and their family receiving mental health (MH) services within a collaborative care model in a multiethnic neighborhood. Method Participants in this study were 140 parent–child dyads that are part of an ongoing longitudinal project looking at the association between individual, familial, social and organizational factors, and outcomes of youth receiving MH services in local health and social service organizations in the Montreal area. Measures included in this study were collected at the initial phase of the longitudinal project (Time 0). Parents completed a sociodemographic questionnaire and the Family Environment Scale (FES), and both parents and children completed the Strength and Difficulties questionnaire (SDQ). Results Results suggest that the family environment, especially family conflicts, has a significant role in the MH problems of children seeking help in collaborative MH services. In this specific population, results also show a trend, but not a statistically significant association, between poverty or immigration and emotional and behavioral problems. They suggest as well that boys show more MH problems, although this could be a contamination effect (parents’ perspective). Conclusions The results support the importance of interventions that not only target the child symptomatology but also address family dynamics, especially conflicts. Collaborative care models may be particularly well suited to allow for a coherent consideration of family environmental factors in youth mental health and to support primary care settings in addressing these issues.

Experience and representations of health and social services in a community of Nunavik

Objectives: The study aims to explore representations and experiences with health and social services in an Inuit community of Nunavik. Methods: A total of 15 semi-structured interviews were conducted with Inuit adults from a community of Northern Quebec. Informal interviews and participatory observation was conducted on six visits over two years. A thematic inductive analysis of data was conducted. Results: Participants’ experiences with care were largely related to the nature of interactions with service providers, and feelings about whether perceived needs were being met. Often these needs were socio-economic. Perceptions of services were based on concepts of trust, privacy and fear of consequences of divulging information, three intrinsically related themes. Conclusions: Reflections must be made on how to address the socio-economic needs of patients and how to go beyond the immediate requests to hear the psychosocial needs that patients might not feel safe to talk about.