Marina Morrow

Shifting Landscapes: Immigrant Women and Postpartum Depression

Utilizing an ethnographic narrative approach, we explored in the Canadian context the experiences of three groups of first-generation Punjabi-speaking, Cantonese-speaking, and Mandarin-speaking immigrant women with depression after childbirth. The information emerging from womens narratives of their experiences reveals the critical importance of the sociocultural context of childbirth in understanding postpartum depression. We suggest that an examination of womens narratives about their experiences of postpartum depression can broaden the understanding of the kinds of perinatal supports women need beyond health care provision and yet can also usefully inform the practice of health care professionals.

Spirituality and treatment choices by South and East Asian women with serious mental illness.

The purpose of this qualitative study is to investigate how South and East Asian immigrant women who have diagnoses of serious mental illness make treatment choices in relation to spirituality and to explore how gender, cultural beliefs, and spirituality intersect with the process of choice. The findings reveal that the process of spiritual choice includes three interrelated phases: (1) identifying contributing factors, (2) exploring spiritual resources and strategies, and (3) living with the choices. Variations among health beliefs and health care decisions are explained and services that women see as being helpful are identified.

Removing barriers to work: Building economic security for people with psychiatric disabilities

Using findings from two studies conducted in British Columbia, Canada, that examined income and employment supports for people with psychiatric disabilities we argue that economic security is essential for mental health recovery, and that supported employment and social enterprise models are well suited to support these goals. We contend that the aims and values underlying neo-liberalism, with its attendant welfare state restructuring, undermine the progressive vision of recovery and the practice of citizenship for people with psychiatric disabilities.

Negotiating Discourses of Shame, Secrecy, and Silence: Migrant and Refugee Women’s Experiences of Sexual Embodiment

In Australia and Canada, the sexual health needs of migrant and refugee women have been of increasing concern, because of their underutilization of sexual health services and higher rate of sexual health problems. Previous research on migrant women’s sexual health has focused on their higher risk of difficulties, or barriers to service use, rather than their construction or understanding of sexuality and sexual health, which may influence service use and outcomes. Further, few studies of migrant and refugee women pay attention to the overlapping role of culture, gender, class, and ethnicity in women’s understanding of sexual health. This qualitative study used an intersectional framework to explore experiences and constructions of sexual embodiment among 169 migrant and refugee women recently resettled in Sydney, Australia and Vancouver, Canada, from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, India, and South America, utilizing a combination of individual interviews and focus groups. Across all of the cultural groups, participants described a discourse of shame, associated with silence and secrecy, as the dominant cultural and religious construction of women’s sexual embodiment. This was evident in constructions of menarche and menstruation, the embodied experience that signifies the transformation of a girl into a sexual woman; constructions of sexuality, including sexual knowledge and communication, premarital virginity, sexual pain, desire, and consent; and absence of agency in fertility control and sexual health. Women were not passive in relation to a discourse of sexual shame; a number demonstrated active resistance and negotiation in order to achieve a degree of sexual agency, yet also maintain cultural and religious identity. Identifying migrant and refugee women’s experiences and constructions of sexual embodiment are essential for understanding sexual subjectivity, and provision of culturally safe sexual health information in order to improve well-being and facilitate sexual agency.

“In My Culture, We Don’t Know Anything About That”: Sexual and Reproductive Health of Migrant and Refugee Women

PurposeMigrant and refugee women are at risk of negative sexual and reproductive health (SRH) outcomes due to low utilisation of SRH services. SRH is shaped by socio-cultural factors which can act as barriers to knowledge and influence access to healthcare. Research is needed to examine constructions and experiences of SRH in non-English-speaking migrant and refugee women, across a range of cultural groups.MethodThis qualitative study examined the constructions and experiences of SRH among recent migrant and refugee women living in Sydney, Australia, and Vancouver, Canada. A total of 169 women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, India, Sri Lanka and South America participated in the study, through 84 individual interviews, and 16 focus groups comprised of 85 participants. Thematic analysis was used to analyse the data.ResultsThree themes were identified: “women’s assessments of inadequate knowledge of sexual and reproductive health and preventative screening practices”, “barriers to sexual and reproductive health” and “negative sexual and reproductive health outcomes”. Across all cultural groups, many women had inadequate knowledge of SRH, due to taboos associated with constructions and experiences of menstruation and sexuality. This has implications for migrant and refugee women’s ability to access SRH education and information, including contraception, and sexual health screening, making them vulnerable to SRH difficulties, such as sexually transmissible infections and unplanned pregnancies.ConclusionIt is essential for researchers and health service providers to understand socio-cultural constraints which may impede SRH knowledge and behaviour of recent migrant and refugee women, in order to provide culturally safe SRH education and services that are accessible to all women at resettlement irrespective of ethnicity or migration category.

Conceptualizing depression in Vietnam: Primary health care providers’ explanatory models of depression:

The purpose of this qualitative study was to elicit the explanatory models (EMs) of primary healthcare providers (PHPs) in Vietnam in order to (a) understand if and how the concept of depression is understood in Vietnam from the perspective of nonspecialist providers and community members, and (b) to inform the process of introducing services for depression in primary care in Vietnam. We conducted semistructured interviews with 30 PHPs in one rural and one urban district of Hanoi, Vietnam in 2014. We found that although PHPs possess low levels of formal knowledge about depression, they provide consistent accounts of its symptoms and aetiology among their patient population, suggesting that depression is a relevant concept in Vietnam. PHPs describe a predominantly psychosocial understanding of depression, with little mention of either affective symptoms or neurological aetiology. This implies that, with enhanced training, psychosocial approaches to depression care would be appropriate and acceptable in this context. Distinctions were identified between rural and urban populations in both understandings of depression and help-seeking, suggesting that enhanced services should account for the diversity of the Vietnamese context. Alcohol misuse among men emerged as a considerable concern, both in relation to depression and as stand-alone issue facing Vietnamese communities, indicating the need for further research in this area. Low help-seeking for depression in primary care implies the need for enhanced community outreach. The results of this study demonstrate the value of eliciting EMs to inform planning for enhanced mental health service delivery in a global context.

Dangerous Discourses: Masculinity, Coercion, and Psychiatry

In British Columbia, the introduction of modified Assertive Community Treatment Teams (ACT), a form of multi-disciplinary community-based treatment, recently began to include police as part of their professional complement. This chapter explores the intersections of masculinity, psychiatric diagnosis, and discourses of dangerousness as they play out in coercive practices in community-based settings. We expose the ways in which these damaging practices crop up in new and innovative ways in community-based mental health, giving lie to the promise of recovery and person-centred models of mental health care. We contextualize our discussion through a historical examination of the role of psychiatric confinement and its links to colonialism and intersecting forms of oppression and discuss the implications of ‘new’ forms of psychiatric violence and coercion for the lives of men diagnosed with mental illness.

Stigma associated with mental illness among Asian men in Vancouver, Canada

Background: Due to racism, xenophobic nationalism, acculturation pressures and patriarchal social relations, Asian men in Western societies may be particularly susceptible to negative experiences and beliefs regarding mental illness and treatment services. Aims: We examine factors associated with stigma toward mental illness among Asian men in Canada. Methods: Between 2013 and 2017, 428 self-identified Asian men living in proximity to Vancouver, Canada, were recruited and completed self-administered questionnaires assessing social stigma and self-stigma. The degree to which these variables were associated with the men’s sociodemographic characteristics was analyzed. Results: Multivariable regression revealed that social stigma was significantly predicted by age, immigration, employment status and experience with mental illness. Together, these variables accounted for 12.36% of variance in social stigma. Interaction terms were added to the regression models to examine whether the effects of immigration on social stigma varied by age and experience with mental illness, but none of the interaction terms were statistically significant. Among the 94 Asian men identified as living with mental illness, self-stigma was predicted by age, immigration and employment status, which together accounted for 14.97% of variance in self-stigma. Conclusion: These results offer new knowledge about the factors predicting stigma toward mental illness among Asian men in Western societies.

Intersectional policy analysis of self-directed mental health care in Canada.

Objective: Recovery from mental illness is influenced by one’s social location along multiple dimensions of identity, such as race, class, gender, age, and ability, and by how these social locations are expressed through structural and institutional barriers. This project was developed using an intersectional policy analysis framework designed to promote equity across identity locations–called the multistrand method–to examine the potential use of self-directed care financing approaches in the Canadian mental health system. Method: A panel of 16 diverse stakeholders came together 4 times at structured 6-hr meetings to examine the evidence for self-directed care and explore its application in the Canadian context. Telephone interviews with evidence panel members were conducted to assess their perceptions of the group process and outcomes. Results: Our analysis revealed ways that intersecting strand locations might differentially influence the degree of choice and recovery experienced by self-directed care participants. Individualized resource allocation, draining financial resources from ethnically specific services, unevenness in acceptance of the recovery orientation, and paucity of service options in different geographical regions were identified as contexts in which self-directed care policies could promote inequity. However, greater peer involvement in the model’s implementation, use of indigenous community supports, purchase of material goods by economically disenfranchised persons, and access to services from ethnically diverse clinicians in the private sector were identified as equity-promoting model features. Conclusion and Implications for Practice: By couching their analysis at the level of unique socially-situated perspectives, the group developed detailed policy recommendations and insights into both the potential and limitations of self-directed care. The knowledge gained from our project can be used to develop uniquely Canadian self-directed care models tailored to promote recovery through empowerment and self-determination across intersecting identity strand locations.

After the Asylum in Canada: Surviving Deinstitutionalisation and Revising History

Psychiatric deinstitutionalisation began in Canada in earnest during the 1960s and continues today. The downsizing and closure of custodial mental hospitals did not occur uniformly across the country, and regional variations in government, healthcare staff and community care policies profoundly shaped the process. The Saskatchewan Mental Hospital at Weyburn, the last asylum built in the Victorian style in the British Commonwealth, was the first to shut its doors, which it did dramatically in 1963. Others closed in stages, emptying wings and transitioning into outpatient care facilities or, as was the case in Alberta, repurposing the buildings for brain injured patients requiring shorter-term stays. Some facilities remained open with a reduced patient population and abandoned sections of the hospital that no longer conformed to the standards for privacy or health and safety regulations. Eastern Canadian provinces like Nova Scotia had not subscribed to large-scale custodial institutions in the first place, and while deinstitutionalisation from cottage-style facilities also occurred, the pace and impact of that change was profoundly different for staff, communities and ex-patients. Several Ontario-based institutions centralised their services, closing some and enlarging others. British Columbia’s iconic Riverview mental hospital continued to exist partially until 2012, looming large in cultural memory, as did many of these other monuments to what soon became a bygone era of psychiatric care. This regional variation in service delivery has in part characterised deinstitutionalisation in Canada, and also helps to underscore how patients from place to place may have encountered very different circumstances as they moved out of institutional care.